[Therapeutic strategy for the treatment of non-infectious uveitis proposed by an expert panel]. / Avis d'experts pour le traitement des uvéites non infectieuses.

Conventional immunosuppressive drugs, anti-TNF alpha and other biotherapies used in clinical practice are capable of controlling non-infectious anterior uveitis, posterior uveitis and panuveitis. The present work has been led by a multidisciplinary panel of experts, internists, rheumatologists and ophthalmologists and is based on a review of the literature. In case of corticodependency or sight-threatening disease, conventional immunosuppressive drugs (methotrexate, azathioprine and mycophenolate mofetil) and/or anti-TNF alpha (adalimumab, infliximab) are used to achieve and maintain remission. Interferon is an efficient immunomodulatory treatment, as a second-line therapy, for some therapeutic indications (refractory macular edema, Behçet's vascularitis). Other biologics, especially tocilizumab, are showing promising results. Local treatments (corticosteroids, sirolimus etc.) are adjuvant therapies in case of unilateral inflammatory relapse. Therapeutic response must be evaluated precisely by clinical examination and repeated complementary investigations (laser flare photometry, multimodal imaging, perimetry, electroretinography measures).

Biotherapies in inflammatory ocular disorders: Interferons, immunoglobulins, monoclonal antibodies.

Biotherapies used in clinical practice for the treatment of ophthalmologic manifestations of systemic diseases include interferons (IFN), intravenous immunoglobulins (IVIG) and monoclonal antibodies (anti-TNF, anakinra, tocilizumab and rituximab). Several open prospective studies have shown the effectiveness of IFN-α (78 to 98% complete remission) for the treatment of severe uveitis in Behcet's disease. IFN is capable of inducing prolonged remission and continued after his arrest, in 20-40% of patients. Side effects (flu-like, psychological effects) limit its use in practice. Anti-TNFα (infliximab and adalimumab) represents an attractive alternative therapeutic in severe uveitis refractory to immunosuppressants, especially in Behcet's disease. They are almost always (>90% of cases) and rapidly effective but their action is often suspensive. Anti-TNFα requires an extended prescription or takes over from another immunosuppressant once ocular inflammation has been controlled. IVIG are used for the treatment of Kawasaki disease and Birdshot disease. Several open or retrospective studies showed their effectiveness for the treatment of severe and refractory cicatricial pemphigoid. Tolerance of IVIG is good but their efficacy is transient. Rituximab showed an efficacy in few observations of various inflammatory eye diseases (uveitis, scleritis and idiopathic inflammatory pseudo-tumors or associated with granulomatosis with polyangiitis) and cicatricial pemphigoid. The risk of infection associated with this biotherapy limits its use in refractory diseases to conventional therapy. Anakinra (a soluble antagonist of IL-1R) showed interesting results in terms of efficiency in one small open study in Behcet's disease. Its safety profile is good and with a quick action that could be interesting for the treatment of severe uveitis.

[Efficacy of moxifloxacin in treating bacterial conjunctivitis: a meta-analysis]. / Efficacité de la moxifloxacine dans le traitement de la conjonctivite bactérienne aiguë : une méta-analyse.

PURPOSE: To estimate the effectiveness of moxifloxacin instillation in the treatment of bacterial conjunctivitis. PATIENTS AND METHODS: Five randomized clinical trials on moxifloxacin were identified, three versus placebo, one versus ofloxacin, and another versus levofloxacin. The effectiveness parameters included clinical efficacy and drop-out rates for all reasons including lack of efficacy. The fixed and random effects were estimated on intent-to-treat populations. Models for risk ratios and risk differences as well as tests for study homogeneity were computed. RESULTS: Patients treated with moxifloxacin dropped out less frequently (OR=2.22 [1.62-3.03]; p<0.001), had less treatment failure (OR=3.61 [2.30-5.65]; p<0.001), and experienced clinical cure more often (OR=1.59 [1.21-2.04]; p=0.001) than placebo-treated patients. In comparison to ofloxacin, patients treated with moxifloxacin had fewer drop-outs for reasons other than treatment failure (OR=1.92 [1.28-2.89]; p=0.02) and fewer drop-outs for treatment failure (OR=2.53 [1.41-4.56]; p=0.002). CONCLUSION: This meta-analysis demonstrated the clinical efficacy of moxifloxacin compared to placebo. Fewer patients dropped out from moxifloxacin treatment compared to ofloxacin.

[Retinal detachment caused by ocular perforation during periocular anesthesia: three case reports]. / Décollement de rétine par perforation oculaire au cours d'anesthésies péri-oculaires: à propos de trois cas.

INTRODUCTION: Local anesthesia for eye surgery was first described in 1884; later Knapp popularized retrobulbar anesthesia. To reduce risks, peribulbar anesthesia appeared in the 1970s. Still used today, periocular anesthesia is not without complications, in particular the risk of ocular perforation. PATIENTS AND METHODS: Three patients were referred to our department for diagnosis and treatment of an intravitreous hemorrhage following cataract surgery. We report the clinical features, treatment, and visual outcome for these three patients. RESULTS: The most common presentation was vitreous hemorrhage: the three eyes were found to have associated retinal detachment on initial assessment. One patient presented severe vitreoretinal proliferation with two postoperative recurrences; the globe was finally enucleated. The two other patients presented attached retina after surgery but had achieved very poor visual recovery. CONCLUSION: Inadvertent globe perforation during local ocular anesthesia is rare. Careful attention to risk factors, early recognition, and prompt referral for management are recommended to improve the visual prognosis. Surgical management must be adapted to the severity of the perforation (vitreous hemorrhage, retinal detachment, vitreoretinal proliferation). The problems treating these patients with severe, often recurrent, retinal detachment, with poor visual prognosis, in a tricky forensic context should be emphasized.