[Lacrimal system trauma]. / Traumatologie lacrymale.

Among lacrimal system injuries, canalicular lacerations are at the top of the list. Men are more affected than women, but children are most likely to experience such trauma. The cause depends on the patient's age: in young children, there is a higher prevalence of animal bites (dogs and cats); in young adults, fights predominate, since motor vehicle accidents have become less common; in the elderly, falls are among the most frequent causes. Tetanus vaccination is required in all cases, but assessment for rabies exposure is necessary in the case of dog or cat bites. Diagnosis is very simple: it is based on examination or wound probing. Other head, facial, or ocular injuries must be excluded; for example, an injury to the globe must take precedence over a canalicular laceration. In the absence of an ocular injury, the canalicular wound should be managed surgically within 48hours under an operating microscope: identification of both severed ends of the injured canaliculus, suture of the severed canaliculus with monofilament suture, and appropriate lacrimal intubation if indicated. Other trauma to the lacrimal system, such as sharp or blunt trauma to the lacrimal sac or nasolacrimal duct, are much rarer.

[Is Holladay 2 formula acurate enough for calculating intraocular lens power in non-standard eyes?] / Intérêt de la formule Holladay 2 dans le calcul de la puissance de l'implant intraoculaire pour les yeux de biométrie hors normes.

PURPOSE: To evaluate the benefit of the Holladay 2 formula versus the 3rd generation formulae in calculating the IOL power in eyes with non-standard axial length or keratometry before cataract surgery. PATIENTS: Retrospectiv study from January to December 2015. The inclusion critaeria were axial length (AL) <22mm or >26mm, or average keratometry <42 D or >46 D, dividing the patients in 4 groups respectively. The 7 parameters required to calculate the Holladay 2 formula were collected. The final refractive result was turned into spherical equivalent to calculate the optimal power retrospectively. Then, the results obtained using the other formulae were compared with the optimal IOL power. RESULTS: One hundred and twenty-six eyes operated by two surgeons were included. In the high AL group (n=32), the SRK/T was the most accurate formula; regarding the low AL group (n=36), the Hoffer Q and Holladay 2 formulae performed better; for the steep cornea group (n=27), the Hoffer Q, Haigis, Holladay 1 and 2 formulae were not different; last, the Holladay 1 and 2 were more accurate in the flat cornea group (n=33). CONCLUSION: In our study, the Holladay 2 formula does not seem to be better than the others for calculating IOL power in non-standard eyes. Preoperative eye features in such non-standard cases should be taken into account before the surgery to choose the more suitable formula.

[Diagnostic and therapeutic contribution of microbiological analysis in severe microbial keratitis at Reims University Hospital between 2012 and 2014]. / Apport diagnostique et thérapeutique des prélèvements microbiologiques des abcès de cornées avec critères de gravité au CHU de Reims entre 2012 et 2014.

PURPOSE: To investigate the contribution of microbial analysis in the diagnosis and management of severe microbial keratitis. MATERIAL AND METHOD: This is a monocentric retrospective study at the University Hospital of Reims from January 2012 to December 2014. Corneal scrapings with infectious keratitis were subjected to routine bacterial and fungal culture. PCR was also performed to detect various viral DNA (VZV, CMV, EBV, HSV 1 & 2, adenovirus) and Acanthamoeba sp. DNA. All contact lens cases were analyzed if available. RESULTS: One hundred and six patients were hospitalized, including 30 contact lens wearers (28.3%). Sixty-four bacterial cultures were positive (68%). Twenty-five different bacterial species were identified with a majority of gram-positive bacteria (67.92%). Among contact lens wearers, the initial VA was better than non-wearers (P=0.0004) and 37% of bacteria identified (a plurality) were gram positive. Of 11 contact lens case analyzed, in only one case (3.3%) did the result correlate with the corneal culture. Only 9 samples from the 323 viral DNA extractions and real time PCR were positive (2.8%); 7 were HSV1. No prior antiviral therapy had been started. Fungal culture was positive in 2 of the 97 corneal samples taken and 63.6% of the contact lens cases (7/11 cases). Only one of the 40 Acanthamoeba sp. PCR's was positive. CONCLUSION: The systematic performance of microbiological investigations is a good diagnostic approach given the polymorphism of clinical presentations of corneal ulcers, which can sometimes be extremely misleading. Culture of contact lens cases appears ineffective for the detection and determination of the causative microorganism. The high incidence of Staphylococcus in bacterial keratitis and the prevalence of infections with gram-positive bacteria in contact lens wearers were noted.

[Adult orbital tumors]. / Tumeurs de l'orbite de l'adulte.

Orbital tumors are a rather frequent pathology. Their diagnosis and treatment may be difficult. They can be benign or malignant. All the tissues of the orbit can give rise to a tumor, resulting in their large number. Among the benign tumors, we have meningiomas and cavernous hemangiomas, and for the malignant tumors, lymphomas, metastasis, ENT tumors and lacrimal gland tumors in the adult. Usually the signs are nonspecific, with proptosis, oculomotor disturbance, inflammatory signs, pain and sometimes a mass. Imaging (CT, MRI and color Doppler ultrasound) shows the tumor, its location, extent and possible metastases. Biopsy and anatomic and cytopathologic examination confirm the type of benign or malignant tumor. Based on these three elements: clinical appearance, imaging and histology, the tumor will be treated, usually by a surgical approach according to the recommendations of a multidisciplinary tumor conference. Radiation therapy and chemotherapy may supplement the treatment.

[Lacrimal traumatology]. / Traumatologie lacrymale.

Lacrimal system injuries represent a significant part of ocular emergencies and mainly affect males of various ages including very young children. The most frequent presentations are canalicular laceration with a palpebral wound medial to the lacrimal punctum. The inferior canaliculus is the most commonly affected but bilateral injuries or injuries affecting both canaliculi can occur. The main causes are dog bites in children, scuffles in young adults and falls in elderlies. Antitetanic and antirabic measures have to be considered for open cases. The diagnosis is easily made by inspection and can be confirmed by probing. Other lesions can be associated and require proper identification, especially eyeball laceration requiring surgical repair within 6 hours. Otherwise, isolated canalicular wounds are to be repaired within 48 hours by an anastomotic suture with or without mono- or bi-canalicular silicone intubation. Other lacrimal tract injuries involving the lacrimal sac or the nasolacrimal duct are rare, commonly associated with blunt craniofacial trauma or iatrogenic after some surgical procedures.

Association of endothelial lipase Thr111Ile polymorphism with proliferative retinopathy in type 2 diabetes patients.

AIM: Our previous study demonstrated that the endothelial lipase (EL) C.584C>T polymorphism (rs2000813, p.Thr111Ile) was significantly associated with diabetic retinopathy (DR). The present work was conducted to see if this specific variant of the EL gene was more specifically linked to the severity of DR. METHODS: This retrospective cohort study was based on a review of the institutional charts of 287 type 2 diabetes patients (mean age = 59.7 years; mean BMI = 29.0 kg/m(2); mean HbA1c=8.4%) genotyped for the EL C.584C>T polymorphism (rs2000813, p.Thr111Ile). The stage of DR was also determined for each genotype (CC, CT, TT). RESULTS: On univariate analysis, the minor allele homozygote TT variant was significantly associated with severe DR (OR: 4.3; 95% CI: 1.4, 13.1) compared with the major CC homozygote. No significant result was found for the CT heterozygote. Multivariate analysis revealed an increased risk for TT homozygotes to present with severe non-proliferative DR (OR: 8.09; 95% CI: 1.23, 53.1) or proliferative DR. Other associations were not significant. CONCLUSION: Minor allele homozygosity for this EL variant (c.584C>T) could be a significant risk factor for developing severe, sight-threatening disease due to proliferative DR. Further prospective studies of this EL polymorphism in a larger population sample are needed to confirm these results.

[Tonometric response to acetazolamide in patients with retinal detachment]. / Réponse tonométrique à l'acétazolamide dans le décollement de rétine.

INTRODUCTION: Acetazolamide reduces intraocular pressure and stimulates absorption of subretinal fluid by the retinal pigment epithelium. Recording the intraocular pressure response to systemic acetazolamide might enable an indirect evaluation of retinal pigment epithelial carbonic anhydrase. METHODS: The intraocular pressure response to a standardized dose of intravenous acetazolamide (5mg/kg) was evaluated in a "case" group of 15 patients undergoing retinal detachment (RD) surgery and in a control group of 15 patients undergoing epiretinal membrane peeling. Intraocular pressure was measured with a handheld Perkins tonometer in a supine position before (t-2 min) and after the intravenous administration of acetazolamide (t+2 min, t+6 min, t+10 min and t+30 min). The mean variation of the intraocular pressure was compared between the two groups in the non-operated eye at each time point. RESULTS: A significant reduction of the intraocular pressure was observed in both groups at 2, 6 and 10 minutes (P<0.01) after the injection of acetazolamide (5mg/kg). The reduction was significantly lower in the group of patients who underwent retinal detachment surgery when compared with the group of patients in whom epiretinal membrane peeling had been performed. This difference remained significant up to 10 minutes (P<0.01 at t=2, 6 and 10 min). At t=30 min, the intraocular pressure reduction was comparable in both groups. DISCUSSION: The vitreous plays a fundamental role in the pathogenesis of retinal detachment via peripheral traction. However, since not all tears lead inevitably to retinal detachment, there must also be adherence factors which can prevent the latter. The response to acetazolamide differs significantly in patients undergoing retinal detachment surgery compared with patients treated with epiretinal membrane peeling. In the occurrence of retinal detachment, deficient photoreceptor adherence to the retinal pigment epithelium has been hypothesized. Further research should aim to correlate the tonometric response to acetazolamide with photoreceptor adherence.

Comparison of clinical efficacy: Nd:YAG laser rates after implantation of AcrySof® SN60WF, Akreos® AO-MI60 and Hoya® YA-60BB.

PURPOSE: To compare Nd:YAG laser rates following implantation of AcrySof(®) SN60WF (Alcon), Akreos(®) AO-MI60 (Baush & Lomb), and Hoya(®) YA-60BB (Hoya) intraocular lenses. METHODS: This retrospective study was conducted at three French centers with each implanting at least two of the three implants. Included patients had undergone uncomplicated cataract surgery with at least 3 years of follow-up. Records of patients implanted with one of the three IOL's were drawn randomly from the surgical logs. Postoperative data were obtained from the medical records of either the surgeon or the referring physician. Time elapsing until Nd:YAG laser was analysed using Kaplan-Meier survival curves. RESULTS: Three hundred eyes were implanted (AcrySof(®) 126, Akreos(®) 89, and Hoya(®) 85). AcrySof(®) recipients were the youngest (AcrySof(®) 72.1, Akreos(®) 76.4, and Hoya(®) 75.2 years of age: P=0.0007). The sex ratio was 4:6 male:female. Follow-up was longest for Hoya eyes (AcrySof(®) 29.4, Akreos(®) 24.6 and Hoya(®) 34.6 months; P=0.0002). Eyes implanted with AcrySof(®) had 1.74 times less chance of Nd:YAG laser treatment than Hoya eyes (P=0.0327) and 3.50 times less than Akreos(®) eyes (P<0.0001). The results remained unchanged when the analysis was restricted to events in the first 24 months (Risk Ratios: Hoya(®)=2.64: P=0.02; and Akreos(®)=4.22: P=0.0001). Adjustment on unbalanced confounding variables did not alter the results. CONCLUSIONS: Eyes with AcrySof(®) implants required significantly fewer Nd:YAG laser capsulotomies than those with Hoya(®) and Akreos(®) implants and were therefore less subject to Nd:YAG laser treatment complications, thus ensuring better vision at the lowest cost.

[Optical coherence tomography in neuro-ophthalmology]. / Tomographie par cohérence optique (OCT) en neuro-ophtalmologie.

INTRODUCTION: Optical coherence tomography (OCT) is a potential tool for diagnosis and follow-up in diseases of the anterior visual pathway in that it provides a reproducible and reliable quantification of retinal nerve fiber layer (RNFL) thickness. A review of the literature was conducted to define the utility of OCT in neuro-ophthalmology. MATERIALS AND METHODS: The clinical applications of RNFL thickness measurement by OCT time domain were analyzed. The PubMed search engine enabled us to select the relevant publications, using the following keywords: "optic neuropathy", "retinal nerve fiber layer thickness", and "optical coherence tomography". Publications concerning glaucoma were excluded from this review. RESULTS: The course of RNFL thickness depends on the underlying disease: (I) progressive reduction toward atrophy (e.g., optic neuritis, chiasmal compression) or (II) initial increase in RNFL thickness followed by a reduction toward (IIa) normalization (papilledema) or (IIb) atrophy (anterior ischemic optic neuropathy, Leber hereditary optic neuropathy). DISCUSSION: Depending on the type of anterior visual pathway impairment, OCT provides RNFL data relevant for diagnosis, follow-up, and prognosis. As in macular disease, OCT has become an important clinical tool for routine disease assessment in neuro-ophthalmology.

Genomic structure, polymorphism and expression of the horse alpha-actinin-3 gene.

Gene characterization is an important feature for genome annotation and more particularly for candidate genes that could be selected in domestic species. Associations between an alpha-actinin-3 gene polymorphism and muscle performance were reported in humans involving a nonsense mutation (R577X) and in mice after inactivation of the gene. Here, we characterized the equine alpha-actinin-3 (ACTN3) gene by sequencing and transcript analysis. The cDNA was determined to be 3.47 kb in length with an open reading frame of 2709 bp expectedly encoding a protein 902 amino acids long. The ACTN3 gene is 13.2 kb long and contains 21 exons. The equine ACTN3 gene has a ubiquitous expression but it is overexpressed in skeletal muscles with fast fibers of type IIb. No alternative transcripts were observed. Sequencing the cDNA revealed 8 SNPs, 6 in the coding and 2 in the 3' non-coding regions with no amino acid change and not affecting potential miRNA targets. The equine in silico promoter sequence reveals a structure with two regions similar to those of other mammalian species.

[Breast adenocarcinoma discovered by orbital metastases: a case report and review of the literature]. / Un adénocarcinome mammaire découvert par une métastase orbitaire : à propos d'un cas et revue de la littérature.

Ocular metastasis of breast cancer has become more frequent since therapy increases patients' survival. It is therefore important to recall this diagnosis. We report the case of a 73-year-old patient who had orbital metastases of an unknown breast cancer. The commonest clinical sign at diagnosis is exophthalmia. Prognosis is usually pejorative once diagnosis is performed. Standard treatment is radiotherapy and requires a multidisciplinary approach.

[Screening for retinal detachment using wide-field retinal imaging]. / Dépistage du décollement de rétine par l'utilisation d'une imagerie panrétinienne.

PURPOSE: The wide-field retinal imaging device (200°) (P200 Optomap Plus, Optos, Edinburgh, Scotland, UK), using a scanning laser ophthalmoscope (SLO), makes it possible to visualize a wide retinal area including the retinal periphery. The present study was designed to evaluate the ability to detect peripheral rhegmatogenous lesions using SLO wide-field image reading. METHODS: Between 2 November 2007 and 30 April 2008, all patients presenting with a retinal detachment were prospectively enrolled. Retinal ophthalmoscopy and drawing of retinal detachment, breaks, and holes were performed by a single retinal surgeon. SLO imaging was performed by an orthoptist and image reading by a senior resident. The orthoptist and the resident were both unaware of the results of the clinical examination. The extension of the retinal detachment in clock hours as well as the number of breaks and holes were compared between the retinal drawing and the image reading results. RESULTS: During the study period, 6053 images were taken, in 56 eyes with retinal detachment documented. Retinal breaks and holes were detected in seven of 10 cases with SLO image reading, only those situated superiorly between 11 and 1 o'clock and inferiorly between 5 and 7 o'clock were missed. Retinal detachments (one situated superiorly and one situated inferiorly) were detected in nine of 10 cases. CONCLUSIONS: The sensitivity of retinal detachment detection with the wide-field imaging device appears to be satisfactory for screening purposes, although it cannot replace retinal ophthalmoscopy.

Association of endothelial lipase Thr111Ile polymorphism with lipid metabolism and microvascular complications in type 2 diabetic patients.

AIM: Endothelial lipase (EL) is a key enzyme in lipid metabolism, and a polymorphism in the EL gene may be a candidate for modulating lipid parameters in type 2 diabetic (T2D) patients. METHODS: In 396 T2D patients (age: 59.5 ± 10.7 years; BMI: 28.9 ± 5.3 kg/m(2); HbA(1c): 8.2 ± 1.9%), the c.584C>T polymorphism (rs2000813, p.Thr111Ile) was studied in 225 men (frequency of c.584T: 0.351) and 171 women (frequency of c.584T: 0.304). Patients' metabolic parameters, and macrovascular and microvascular complications, were assessed at baseline and at follow-up (mean: 4.2 years). RESULTS: Patients who were homozygous for the minor allele displayed modestly decreased low-density lipoprotein (LDL) cholesterol and raised apolipoprotein B at baseline, and raised systolic blood pressure and high-density lipoprotein (HDL) cholesterol on follow-up. Homozygosity for the minor allele was significantly associated with frequency of retinopathy (P=0.025), with TT homozygous patients more likely to have diabetic retinopathy (OR: 3.505; 95% CI: 1.491-8.239) both initially and at follow-up. CONCLUSION: The c.584C>T EL polymorphism is associated with a higher risk of diabetic retinopathy that could be linked to modifications in HDL-cholesterol metabolism and blood pressure levels.

Genomic structure, polymorphism and expression of ACCN1 and ACCN3 genes in the horse.

A category of cation gate proteins was shown to be present in sensory neurons and act as receptors of protons present in tissues such as muscles. The Amiloride-sensitive Cation Channel, Neuronal (ACCN) gene family is known to play a role in the transmission of pain through specialized pH sensitive neurons. Muscles from horses submitted to strenuous exercises produce lactic acid, which may induce variable pain through ACCN differential properties. The sequences of the equine cDNAs were determined to be 2.6 kb in length with an open reading frame of 1539 bp for ACCN1 and 2.1 kb in length with an open reading frame of 1602 bp for ACCN3. The ACCN1 gene is 990 kb long and contains 10 exons, and the ACCN3 gene is 4.2 kb long and contains 11 exons. The equine ACCN1 and ACCN3 genes have an ubiquitous expression but ACCN1 is more highly expressed in the spinal cord. We identified one alternative ACCN3 splicing variant present in various equine tissues. These mRNA variants may encode two different protein isoforms 533 and 509 amino acids long. Ten single nucleotide polymorphisms (SNPs) were detected for ACCN1; five in the coding and five in the non-coding region, with no amino acid change, while the three SNPs identified in the coding region of the ACCN3 gene introduce amino acid changes. The equine in silico promoter sequence reveals a structure similar to those of other mammalian species, especially for the ACCN1 gene.

[CT dacryocystography: normal findings and pathology]. / Dacryoscanner: aspects normaux et pathologiques.

CT dacryocystography, performed under sterile technique and following local anesthesia, is well tolerated by patients. It is the imaging technique of choice in patients with persistent tearing following clinical examination with non-invasive procedures when patency of the lacrimal drainage system remains uncertain, when a dacryolith or tumor is suspected or following unsuccessful dacryocystorhinostomy. Two techniques are available: instillation or direct cannulation, either initially or after non-visualization of the nasolacrimal system after contrast instillation. Non-specific idiopathic stenosis at the mid portion of the nasolacrimal duct is the most frequent etiology in patients over 50 years old; dacryoliths are present in 5 to 20% of cases of nasolacrimal duct stenosis. CT dacryocystography also allows evaluation of surrounding structures (medicolegal) to identify variants and anomalies when surgery is contemplated to avoid potential complications.

[Palpebral and lacrimal system injuries in children]. / Plaies palpébro-lacrymales de l'enfant.

The authors report the different palpebral and lacrimal wounds found in children and their treatment. Early microscopic surgery is important for good prognosis. The eyelids must be thoroughly examined searching for a marginal injury, superior palpebral levator muscle resection, and lacrimal system injury after ocular injuries have been investigated. The treatment is microscopic surgery of the eyelid and the canaliculus with most often a monocanalicular intubation. The authors present two clinical studies conducted in the Reims Hospital that show the frequency of this traumatology and the main characteristics. In children, most injuries come from dog bites with canalicular laceration in the left lower eyelid. In palpebral injuries without canalicular section, the injury was most often located on the right lower eyelid. Preliminary treatment of childhood palpebral and lacrimal injuries is necessary with microscopic surgery. It is important to repair the canaliculus with or without canalicular intubation and the eyelid margin.

[Practical management of proptosis]. / Conduite pratique à tenir devant une exophtalmie.

The authors report on the management of proptosis. It must first be recognized clinically and confirmed by means of exophthalmometry. The clinical aspects of the proptosis must be described: axial, pulsatile, etc. Radiology and pathology contribute to determining the etiology: Doppler color echography, RX scanner, and MRI can give important details arguing for inflammation (Graves ophthalmopathy or orbital nonspecific inflammation) or orbital tumor. Biopsy or full biopsy in case of suspected tumor provide the diagnosis. The main causes of proptosis are Graves orbitopathy, nonspecific inflammatory orbitopathy, orbital tumor, orbital infection, and orbital injury.

[Immunohistochemistry in ophthalmic pathology: applications and limitations]. / L'immunohistochimie en anatomie pathologique ophtalmologique: intérêt et limites.

We evaluate the applications of immunohistochemistry (IHC) in ophthalmic cytology and pathology. The principles of the techniques used in IHC are described. Recent improvements are highlighted, such as the polymeric labeling two-step method, tyramine signal amplification, rabbit monoclonal antibodies, and labeled nanocrystals. The results of the immunohistochemical methods are collected in bacterial and viral diseases and in tumors of the eye and its adnexa, the pathology of which varies greatly. The results in lymphomas, melanomas, and palpebral tumors were more details for practical reasons. There are widespread applications of IHC in ophthalmic pathology, extending from viral ocular and general diseases to the diagnosis of tumors. In some conditions, this technique needs to be associated with molecular biology investigations. Automation helps establish standard protocols, but IHC is a multistep diagnostic method requiring proper selection, fixation, processing, and staining procedures. From a general standpoint, good communication between pathologists and ophthalmologists is the best guarantee of satisfying results.