[Computerized oculomotor training in dyslexia: A randomized, crossover clinical trial in pediatric population]. / Rééducation oculomotrice informatisée dans la dyslexie : essai clinique randomisé en crossover en population pédiatrique.

OBJECTIVE: Several studies have reported abnormal oculomotor capacities leading to reading/writing difficulties among dyslexic children. However, no randomized clinical trial has been conducted to determine whether oculomotor training improves reading/writing skills of these children. The present study aims to evaluate the efficacy of computer-based oculomotor training among dyslexic children. METHOD: Crossover randomized trial with enrollment from January 12, 2015 to July 24, 2015, and follow-up to February 4, 2016. Eleven children (aged 7 to 12 years old) with dyslexia were included in a French psychiatric unit. The computer-based oculomotor training consisted of exercises focused on control of saccadic movements (reflexes and voluntary saccades), vergences and visual attention and memory. At baseline, 3 and 6 months, participants were assessed on reading and writing skills as well as phonological skills, visuo-attentional skills and verbal memory using the French batterie analytique du langage écrit (BALE). Saccadic and antisaccadic ocular movements (latencies and gains) were recorded using a specific device. Several Anova models were performed to test whether oculomotor training improves reading, writing and phonological, verbal memory and visuo-attentional skills. Our analyses were considered exploratory (alpha at 5%). RESULTS: No effect of oculomotor training was found on reading skills. However, oculomotor training was associated with a short-term effect (after 3 months of training) on several tests measuring phonological skills (syllabic suppression; P-value=0.022), visuo-attentional skills (search of anarchic verbal cues; P-value=0.035) and verbal memory (digit span backward; P-value=0.022) and with a long-term effect (3 months after the end of the 3 months of training) on a measure of writing skills (regular words; P-value=0.019). Finally, training was associated with an increase of saccadic latencies indicating an increase of visuo-attentional skills (P-value=0.026). CONCLUSIONS: Our results suggested that computer-based oculomotor training might be effective on writing skills and several cognitive skills among dyslexic children, but future clinical trials are needed to confirm our results.

[IOL choice predictability, 1-year visual outcome, and complications after cataract surgery in children]. / Prédictibilité du choix de l'implant, résultats visuels à 1 an et complications de la chirurgie de cataracte chez l'enfant.

PURPOSE: To measure the refraction 1year after cataract surgery in children as a function of under-correction of the implant power and to evaluate the visual prognosis and possible therapeutic challenges. PATIENTS AND METHODS: We conducted a retrospective study of 28 children (38 affected eyes) who underwent unilateral or bilateral cataract surgery with primary intraocular lens implantation over a one-year period of time. The age at the time of surgery was between 1month and 17years. RESULTS: Ten patients had bilateral cataracts (35%) and 18 patients unilateral (65%). Ten patients were between 0 and 2years of age, 10 patients between 2 and 6years of age, and 8 patients were over 6years old. 72 % of the cataracts were idiopathic. The cataracts were mainly cortico-nuclear (37%). Monocular acuity averaged 0.7 LogMAR (2/10) between 2 and 6years, and 0.2 LogMAR (6.3/10) after 6years. The percentage of under-correction was 31% between 0 and 2years, 12.2% between 2 and 6years, and 2.3% after 6years, for a mean under-correction of 15.2%. The power of the chosen implant after under-correction was 25 diopters on average. One year after surgery, visual acuity averaged 0.2 LogMAR (6.3/10) between 2 and 6years old,and 0.1 LogMAR (8/10) after 6years. The spherical equivalent remained globally stable after surgery (the mean postoperative value was+1.25 diopters). The highest rate of revision surgery occurred in the 0-2year-olds (40%). The most common complication was cellular proliferation (up to 80% of the 0-2year-olds). Only one case of ocular hypertension was noted. DISCUSSION: It is necessary to apply an under-correction of the intraocular lens power, decreasing with the age of the child. The gain in visual acuity is modest, and the main complication is cellular proliferation.

[Vision screening for children: Recommended practices from AFSOP]. / Le dépistage visuel chez l'enfant : les recommandations de l'Association Francophone de Strabologie et d'Ophtalmologie Pédiatrique (AFSOP).

In light of the international literature, a workgroup of experts from the AFSOP met in February 2019 to formulate updated recommendations for visual screening in children. An ophthalmologic examination during the first month of life is recommended for children at risk of developing infantile organic amblyopia. An ophthalmologic examination including cycloplegic refraction between 12 and 15 months of age is recommended for children at risk of developing functional amblyopia. At any age, a prompt ophthalmologic examination is recommended for a child suspected of functional or organic ocular pathology. In children without risk factors or warning signs, a systematic orthoptic screening examination is recommended during the third year of life, including a monocular visual acuity test, a cover-test and a refraction by photoscreener. The child is referred to the ophthalmologist only in the case of an abnormal screening result, according to the following criteria: visual acuity <5/10, or >1 difference between eyes, abnormal cover test, photodetection refraction values <-3D or>+2.5D for the sphere,>1.5D for astigmatism and>1D for anisometropia. Finally, we review normal childhood refractive errors as a function of age as well as the correct use of photo screening devices.

Ocular motility and Wilson's disease: a study on 34 patients.

BACKGROUND: Wilson's disease is an autosomal recessive genetic disorder resulting from an abnormality of copper metabolism. The excessive accumulation of copper in the brain induces an extrapyramidal syndrome. Oculomotor abnormalities occur in most extrapyramidal disorders but have rarely been studied in Wilson's disease. OBJECTIVE: To evaluate the ocular motility manifestations of Wilson's disease. METHODS: A prospective study of 34 patients affected by Wilson's disease who were recruited and their ocular motility recorded by electro-oculography (EOG). RESULTS: Vertical smooth pursuit was abnormal in 29 patients (85%). Vertical optokinetic nystagmus and horizontal smooth pursuit were impaired in 41% and 41% of patients, respectively. No MRI abnormality was found in the lenticular nuclei of seven patients who manifested ocular motility abnormalities. CONCLUSION: Vertical eye movements, in particular vertical pursuits, are impaired in Wilson's disease, more often than vertical optokinetic nystagmus and vertical saccades. EOG abnormalities can be found in patients who do not yet exhibit anatomical lesions on MRI.

[Mydriatic eye drops for children: Analysis of use]. / Collyres mydriatiques en pédiatrie : analyse des pratiques d'utilisation.

Mydriatic eye drops are indicated for ophthalmologic exams (fundus and cycloplegic effect for refraction diagnosis). Their use must be optimal to avoid adverse reactions. This is even more important in pediatrics, because few clinical studies were conducted in this population during drug development. We reviewed the use of mydriatic eye drops, gathering information from the Summary of Product Characteristics (SPC) from the Theriaque® database (CNHIM) and the manufacturers' information, in terms of dose, concentration and volume administered, age limit indications, recommendations for administration, and our local practice. This tool is useful in our hospital for physicians, pharmacists, and nurses but could be also useful for all healthcare providers using mydriatic eye drops for children.

Visual outcomes and complications of cataract surgery with primary implantation in infants.

PURPOSE: To describe the visual results and postoperative complications of cataract surgery with primary intraocular lens (IOL) implantation performed in infants and to determine possible predictive factors related to poor visual outcome. METHODS: A retrospective consecutive case series of cataract surgeries with primary IOL implantation in infants was performed. Visual outcome and postoperative complications were recorded. A final visual acuity>0.5 logMAR was considered as a poor visual outcome. RESULTS: Sixty-one consecutive procedures were evaluated in 43 infants. Eighteen infants (42%) had bilateral cataract surgery and 25 (58%) had monocular surgery. The median age at primary surgery was 5.7 months (range: 4 weeks-24 months). The median follow-up was 47 months (range: 14-60 months). The median best-corrected visual acuity in logarithm of the minimum angle of resolution (logMAR) at the last follow-up examination was 1.00 in the case of unilateral surgery and 0.40 in the case of bilateral surgery. The overall visual result in all eyes was 0.50 logMAR. A better visual result was achieved when the infants were younger than 6 months or older than 12 months of age when surgery was performed. Opacification in the visual axis requiring secondary surgery occurred in 54% of the eyes (33/61). Postoperative inflammation occurred in 41% of the eyes (25/61) but was not associated with poor visual outcome (P=0.39). Glaucoma affected 11.5% of the eyes (7/61) and was significantly associated with poorer visual function (OR: 15.36, 95% CI 1.02-230.35, P=0.05). Compared with the unilateral cataract group, the OR of poor visual acuity was 0.06 (95% CI 0.01-0.35, P<0.01) in the bilateral cataract group. No statistical association was observed between final visual acuity>0.5 logMAR and leukocoria at time of diagnosis, IOL-related complications and postoperative strabismus. CONCLUSIONS: Primary IOL implantation is associated with an overall satisfactory visual outcome, especially when surgery is performed before 6 months or after 12 months of age and in bilateral cases. Glaucoma is the main complication associated with poor visual outcome.

[Comparison of refraction with or without cycloplegia using Retinomax® or Plusoptix® devices]. / Comparaison de la réfraction avec ou sans cycloplégie au Retinomax® vs Plusoptix®.

PURPOSE: To evaluate the refraction in children measured with Plusoptix® without cycloplegia vs. Retinomax® apparatus with cycloplegia. PATIENTS AND METHODS: Measure of refraction with Plusoptix® in children>1year old referred for systematic vision screening, then measurement after cycloplegia with cyclopentolate by the Retinomax® device. RESULTS: Thirty-three children were included, i.e. 66eyes. Mean age was 40.7months (minimum 12; maximum 114). The Spearman correlation coefficient for the spherical equivalent was 0.52 (Plusoptix® vs. Retinomax® comparison; P<0.0001=moderate correlation). The Spearman correlation coefficient was 0.73 for astigmatism (Plusoptix® vs. Retinomax® comparison; P<0.0001=strong correlation). The Plusoptix® sensitivity for measurement of refraction was 57%, 43% and 43% respectively for spherical equivalent, sphere and astigmatism. DISCUSSION AND CONCLUSION: The correlation of astigmatism values is strong, whereas the correlation of sphere values is moderate. Plusoptix® seems to be unable to measure the exact refraction, because there is too large a dispersion of refraction measurements with Plusoptix®, compared to the exact refraction measured with the Retinomax®. Moreover, the sensitivity of Plusoptix® is low. Cycloplegic refraction remains indispensable in children.

[Ophthalmologic prevention of chloroquine and hydroxychloroquine induced retinopathy]. / Prévention ophtalmologique de l'intoxication rétinienne induite par les antipaludéens de synthèse.

INTRODUCTION: Antimalarial drugs induce severe retinal toxicity. The aims of this study were to evaluate the strategy of screening clinical and preclinical intoxication due to antimalarial agents in two centres of reference and to describe the results of ophthalmologic examination. PATIENTS AND METHODS: Patients referred for ophthalmologic evaluation in connection with antimalarial agents therapy in the Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts from October 1999 to December 2000 and in the Hôpital Lariboisière from January 1995 to December 1998 were investigated. A retrospective review of results of ophthalmologic examination, electroretinogram, electro-oculogram, colour vision test and central visual field was conducted to assess retinal intoxication. RESULTS: Among 705 patients recruited in the Centre des Quinze-Vingts, 10 out of 133 who were never treated had an electrophysiological contra-indication to the treatment. Among the 572 other patients, 31 presented with preclinical intoxication (5.4 p. 100) and 8 other patients presented with clinical intoxication. Among 925 patients recruited in the Hôpital Lariboisière, 37 presented with preclinical intoxication (4 p. 100) and four patients presented with clinical intoxication. DISCUSSION: The antimalarial drugs clinical intoxication is rare but nevertheless real. Screening for preclinical intoxication can prevent the evolution toward irreversible retinal intoxication. Diagnosis of preclinical intoxication is established through the confrontation of results of different tests and their evolution. The multifocal electroretinogram remains to be evaluated. CONCLUSION: Ophthalmologic monitoring including funduscopy, should be recommended at least once a year. Visual field seems to become interesting in the screening. Electroretinogram and electro-oculogram remain useful quantitative and obvious tests. A prospective study to assess the optimal way to prevent retinal intoxication is mandatory.

[Managing of retinopathy of prematurity in a tertiary center]. / Prise en charge de la rétinopathie du prématuré en service spécialisé.

INTRODUCTION: Retinopathy of prematurity is a complication of prematurity whose risk factors are well known. Its prognosis remains fearsome and its treatment is difficult. PATIENTS AND METHODS: Fifty-four children were managed (108 eyes analyzed) for retinopathy of prematurity in the Ophthalmology Ward of Necker-Enfants-Malades Hospital between 1996 and 2002. A retrospective review of those cases was performed to describe their clinical features, their treatment and their outcome. RESULTS: Mean gestational age was 26.75 weeks after the mother's last period (24-32.5 weeks) and mean birth weight was 842 g (530-2260 g). Stage zero occurred in ten eyes, stage 1 in two eyes, stage 2 in seven eyes, stage 3 in 42 eyes, stage 4 in ten eyes, stage 5 in 24 eyes, and after-effects stage in 13 eyes. Initial treatment (combined treatments possible) was abstention in 45 eyes, cryotherapy in 16 eyes, laser photocoagulation in 43 eyes, surgical treatment of 13 eyes (scleral buckling or vitrectomy). Cryotherapy was effective in 71.5% of cases, photocoagulation was effective in 77%, and scleral buckling was effective in 25%. Vitrectomy failed in the five eyes treated. Outcome was complicated by legal blindness in 33 eyes. DISCUSSION AND CONCLUSION: The cases of retinopathy of prematurity that we manage are often severe, stage 3 or above, which explains the outcome of the patients. The 7-year experience reported herein shows how difficult it is to manage this condition, though the need for its detection, diagnosis criteria, and therapeutical indications are well known. Because younger and smaller premature newborns are successfully managed by pediatricians, retinopathy of prematurity is far from having vanished and its morbidity is considerable.

[Intraocular pressure elevation after subtenon injection of triamcinolone acetonide during uveitis]. / Hypertonie cortisonique après injection sous-ténonienne de triamcinolone acétonide au cours de l'uvéite.

INTRODUCTION: New therapeutic concepts in the management of ocular inflammation have led to the development of periocular and intravitreal injections. Such treatment modalities can induce intraocular pressure elevation. PATIENTS AND METHODS: Periocular injections have been given to patients suffering from strictly unilateral or bilateral but asymmetrical and noninfectious posterior uveitis. A history of corticosteroid-induced glaucoma was a contraindication to such treatment. A retrospective review of cases who were given subtenon triamcinolone acetonide injection between May and October 2001 was undertaken to evaluate the efficacy of the treatment and the risk of intraocular pressure elevation. Ocular pressure was measured before and after the injection and the efficacy of the treatment was evaluated by measurements of visual acuity and fluorescein angiography. RESULTS: One or several injections were given to 61 patients. Intraocular pressure rose in 13 patients (21.3%). Medical treatment was unsuccessful in three cases and surgical excision of periocular corticosteroid deposit was required. Therefore, intraocular pressure was controlled with no other medication. Treatment was considered effective in 32 patients (52.45%): improvement of visual acuity (more than two lines) or control of inflammation on fluorescein angiography. DISCUSSION: and conclusions: Periocular subtenon injection of triamcinolone acetonide in posterior noninfectious uveitis is a safe procedure. Intraocular pressure elevation is not frequent and can be controlled through medical treatment or surgical excision of a residual deposit, in which pharmacologically active triamcinolone can be present several months after the injection.

[Vitamin K antagonist overdose induced blindness in an infant: an argument for a therapeutic educational program]. / Cécité secondaire à un surdosage en antivitamine K chez l'enfant : un argument pour l'éducation thérapeutique.

INTRODUCTION: Vitamin K antagonist (VKA) treatment is associated with significant risks and requires strict monitoring by measuring the international normalized ratio (INR), either by conventional methods or by self-measurement under medical supervision. We present a case of blindness occurring secondary to a moderate head injury, in a pediatric setting with no VKA therapeutic education. CASE REPORT: A 7-year-old child with a single ventricle had been operated on for a total cavopulmonary shunt at the age of 5 years. He took VKA therapy with an INR target between 2 and 3. After a head trauma, he had a frontal hematoma. His parents did not request a medical exam and did not check his INR. Six days after the injury, the INR was 2.23. The parents went to the emergency ward because the child had bilateral orbital hematoma. At admission, the INR was 5.6. The orbital hematoma was surgically evacuated in the emergency setting. Unilateral blindness occurred and remains a sequelae of the overdose. COMMENTS AND CONCLUSION: VKA treatment requires close supervision to prevent overdose, whose complications such as internal bleeding can have terrible consequences such as the case of blindness reported herein. This case report is a strong argument in favor of an educational program for children with VKA treatment.

[Long-term results of the treatment of optic disc pit associated with serous macular detachment: a review of 20 cases]. / Résultats à long terme du traitement des fossettes colobomateuses de la papille compliquées de décollement séreux rétinien maculaire : à propos de 20 cas.

INTRODUCTION: The pathogenesis of the macular serous retinal detachment (SRD) associated with congenital optic disc pit remains controversial. The treatment is also discussed. Through this study, which includes the majority of the techniques available, we report our experiment in the treatment of this pathology. PATIENTS AND METHODS: This was a retrospective single-centre study of 20 patients who presented with macular SRD associated with optic disc pit between 1983 and 2009. Various treatments were provided. At the beginning of the study, patients were treated only by juxtapapillary laser photocoagulation. After laser failure then as first-line treatment, laser photocoagulation was associated with intravitreal gas (C3F8) injection with postoperative facedown positioning for 2 weeks. During the past few years, all patients have been systematically treated with vitrectomy with or without internal limiting membrane (ILM) peeling, laser, and gas (C2F6) tamponade. RESULTS: This series consisted of 20 patients: nine men and 11 women. The patients' mean age at presentation was 29 years (range, 9-60 years). The mean time between the onset of the decrease in visual acuity (VA) and treatment was 6.1 months. None of these patients had a posterior vitreous detachment at the time of diagnosis. Six patients were treated by laser photocoagulation alone, which was successful only in two cases. Eleven patients (with laser treatment failure in three) were treated by laser and intravitreal gas injection, with a 72% success rate. We performed vitrectomy with posterior hyaloid dissection, laser, and gas tamponade in eight cases (with laser-gas treatment failure in two) with 87% success rate and no recurrence. Five of these patients had ILM peeling during the vitrectomy. The mean follow-up period was 60 months (range, 2 months to 17 years). CONCLUSION: This study shows that early treatment of macular SRD associated with optic disc pit by vitrectomy, ILM peeling, juxtapapillary photocoagulation, and gas tamponade is followed by good anatomical and functional results. This treatment is superior to the other less invasive procedures. Optical coherence tomography is an important exam for diagnosis and postoperative follow-up of patients.

[Severe chloroquine- and hydroxychloroquine-induced retinopathy]. / Intoxication rétinienne sévère aux anti-paludéens de synthèse.

INTRODUCTION: Antimalarial drug-induced retinopathy was first described in the 1950s. Irreversible retinal damage still occurs 50 years later, despite knowledge of the phenomenon. This raises several questions: How aware are physicians of this problem and do they inform their patients? What efficient prevention strategies should be advocated and what are the legal aspects? We present four cases of severe chloroquine- and hydroxychloroquine-induced retinopathy to try to understand what led to these situations. CASE REPORTS: The fist case, a male patient born in 1956, had chloroquine therapy for lupus initiated in 1987, at a dose ranging from 3 to 6 mg/kg per day. In 1992, no toxicity was clinically or electrophysiologically noted. In 1997, macular abnormalities were diagnosed; chloroquine treatment was nevertheless continued. In 2002, the electroretinogram and central visual field examinations were abnormal. Chloroquine treatment was discontinued. In 2005, abnormalities of full-field and multifocal electroretinograms, electro-oculogram, color vision, and visual field confirmed the maculopathy. The second case, a female patient, born in 1956, had chloroquine therapy for rheumatoid arthritis beginning in 1993, at a dose of 5 mg/kg per day. In 1999, 2000, and 2001, electroretinograms were reported as normal. Clinical maculopathy occurred in 2003 and treatment was continued. In January 2004, the central visual field was found abnormal; treatment was discontinued in July 2004. The third case, a female patient born in 1931, had chloroquine therapy for malaria prevention initiated in 1975, at a dose of 1.7 mg/kg per day. No exams were performed after 1983. In 2001, she complained of a left unilateral vision loss. Bilateral maculopathy was clinically found, and confirmed by full-field and multifocal electroretinograms. The fourth case, a female patient born in 1944, had hydroxychloroquine therapy for lupus initiated in 1982 at a dose of 6.9 mg/kg per day. In 2000 and 2002, full-field electroretinograms were reported as normal despite low amplitudes. In 2004, clinical examination was normal, whereas electroretinogram, electro-oculogram, color vision, and central visual field examinations proved severe damage; the treatment was discontinued. DISCUSSION: Retinal damage in these cases was caused by several factors. Treatment was not stopped despite clinically obvious maculopathy in cases 1 and 2. In case 3, no ophthalmologic examinations were performed between 1983 and 2001. In case 4, despite a high cumulative dose, therapy was not discontinued, as also seen in cases 1 and 2, in which ophthalmologic monitoring was not increased. Higher doses than the maximal recommended daily dose occurred in cases 1, 2, and 4. CONCLUSION: Antimalarial drug therapy still requires intensive monitoring to avoid severe retinal damage that can lead to legal blindness. Appropriate examinations should be performed regularly in order to decide whether to taper or stop when damage is still mild, preclinical, or reversible.

[Results of treating rhegmatogenous retinal detachment with vitrectomy and silicone oil tamponade]. / Résultats du traitement du décollement de rétine rhegmatogène par vitrectomie et tamponnement interne par huile de silicone.

INTRODUCTION: Silicone oil is used in the treatment of rhegmatogenous retinal detachment when there is a high risk of postoperative proliferative vitreoretinopathy (PVR). This type of internal tamponade can be responsible for serious side effects. Removal of silicone oil is necessary to ensure a long-lasting functional result. The purpose of this study was to evaluate the results of using a transient internal tamponade with silicone oil. PATIENTS AND METHODS: A retrospective review of cases of rhegmatogenous retinal detachment treated with internal tamponade with silicone oil for the first time in a 1-year period (January 2001 to December 2001) was conducted. We studied the type of retinal detachment, treatment before vitrectomy and silicone oil tamponade, indication for silicone oil tamponade, surgical steps and their results, causes of recurrent retinal detachment, and final visual acuity. Anatomical success was defined as a reattached retina after silicone oil removal. RESULTS: Ninety-three patients were included. Anatomical success was achieved, after one or several procedures, in 71 patients (76.3%). The mean total number of surgical procedures was 2.6. After initial surgery, recurrence of retinal detachment after removal of silicone oil occurred in 17.0% of the cases. Recurrence of retinal detachment under silicone oil occurred in 45.1% of the cases; the cause of the recurrence was PVR in 97.6% of those patients. No serious complication of silicone oil tamponade occurred. The mean duration of the tamponade was 6.7 months. The best results were achieved among patients showing no recurrence with silicone oil: visual acuity above 4/200 in 84.6% of the patients, above 20/200 in 61.5% of the patients and above 80/200 in 20.5% of the patients. In case of recurrence with silicone oil treatment, visual acuity reached 4/200 in 70.4% of the patients and was above 20/200 in 25.9% of the patients. DISCUSSION AND CONCLUSION: The results of this study are equivalent to those of studies in which analysis was made after removal of silicone oil. Proliferative vitreoretinopathy remains the only risk factor of retinal detachment recurrence with silicone oil (p<0.01). The number of previous surgeries is not a risk factor for postoperative PVR. Retinectomy is a surgical procedure that seems to improve the results in cases of severe PVR.