[Development of a learning game for ophthalmic technicians: "Orthoptist Simulator"]. / Développement d'un jeu sérieux pour la formation des orthoptistes : « orthoptist simulator ¼.

INTRODUCTION: E-learning is a pedagogic approach that relies on the use of electronic media and devices as tools to improve access to training, communication and interaction, facilitating the adoption of knowledge, skills and/or behaviors. Learning games offer a learning and training environment using entertaining elements from video games in a real-life scenario. The objective of this work is the conception of a learning game for training ophthalmic technician students. METHODS: Design of a learning game, in collaboration with iLumens and the Dowino® corporation, allowing the performance of an orthoptic evaluation in a child without ocular pathology. RESULTS: We developed the "Orthoptist Simulator" a learning game that faithfully reproduces an orthoptic box with necessary tools to carry out an orthoptic evaluation with ocular motility examination. The game offers learning, training and self-evaluation modes. It allows the student to evaluate a young patient, take a history and perform the 17 most frequently used orthoptic tests. The student thus creates a report of the results of these tests to be transmitted to the ophthalmologist who requested the workup. CONCLUSIONS: To our knowledge, we have set up the first learning game for the training of future ophthalmic technicians, which is an innovative educational tool and complementary to traditional training. This game could also be used to train ophthalmology residents in ocular motility examination. This new instrument will require future evaluation to determine its real impact on training.

[National protocol for diagnosis and care of congenital aniridia: Summary for the attending physician]. / Protocole national de diagnostic et de soins (PNDS) de l'aniridie congénitale : synthèse pour le médecin traitant.

Congenital aniridia is a rare panocular disease defined by a national diagnostic and care protocol (PNDS) validated by the HAS. In most cases, it is due to an abnormality in the PAX6 gene, located at 11p13. Aniridia is a potentially blinding autosomal dominant disease with high penetrance. The prevalence varies from 1/40,000 births to 1/96,000 births. Approximately one third of cases are sporadic. Ocular involvement includes complete or partial absence of iris tissue, corneal opacification with neovascularization, glaucoma, cataract, foveal hypoplasia, optic disc hypoplasia and ptosis. These ocular disorders coexist to varying degrees and progress with age. Congenital aniridia manifests in the first months of life as nystagmus, visual impairment and photophobia. A syndromic form such as WAGR syndrome, WAGRO syndrome (due to the risk of renal Wilms tumor) or Gillespie syndrome (cerebellar ataxia) must be ruled out. Systemic associations may include diabetes, due to expression of the PAX6 gene in the pancreas, as well as other extraocular manifestations. Initial assessment is best carried out in a referral center specialized in rare ophthalmologic diseases, with annual follow-up. The management of progressive ocular involvement must be both proactive and responsive, with medical and surgical management. Visual impairment and photophobia result in disability, leading to difficulties in mobility, movement, communication, learning, fine motor skills, and autonomy, with consequences in personal, school, professional, socio-cultural and athletic life. Medico-socio-educational care involves a multidisciplinary team. Disability rehabilitation must be implemented to prevent and limit situations of handicap in activities of daily living, relying on the Commission for the Rights and Autonomy of People with Disabilities (CDAPH) within the Departmental House of People with Disabilities (MDPH). The general practitioner coordinates multidisciplinary medical and paramedical care.

[Implementation of a new gene therapy in ophthalmology: Regulatory and organizational issues]. / Mise en place d'une nouvelle thérapie génique en ophtalmologie : aspects réglementaires et organisationnels.

Voretigene neparvovec (VN) is the first gene therapy in ophthalmology for patients with RPE65-mediated hereditary retinal dystrophy. It has recently obtained European market approval, which is subject to strict regulatory and organizational conditions for its use. Here, we analyze the main studies supporting the authorization of this new therapy and describe the necessary steps to take at a hospital level for optimal administration to patients following current regulations.

Lipocalin 2 as a potential systemic biomarker for central serous chorioretinopathy.

No systemic biomarker of Central Serous Chorioretinopathy (CSCR) has been identified. Lipocalin 2 (LCN2 or NGAL), alone or complexed with MMP-9 (NGAL/MMP-9), is increased in several retinal disorders. Serum levels of LCN2 and NGAL/MMP-9 were measured in CSCR patients (n = 147) with chronic (n = 76) or acute/recurrent disease (n = 71) and in age- and sex-matched healthy controls (n = 130). Samples with CRP > 5 mg/L, creatinine > 100 µmol/L, and/or urea > 7.5 mmol/L were excluded. Serum LCN2 was lower in CSCR patients than controls (81.4 ± 48.7 vs 107.3 ± 44.5 ng/ml, p < 0.0001), and lower in acute/recurrent CSCR than controls (p < 0.001) and chronic CSCR (p = 0.006). Serum NGAL/MMP-9 was lower in CSCR patients than controls (47.2 ± 40.7 vs 74.1 ± 42.6, p < 0.0001), and lower in acute/recurrent CSCR than controls (p < 0.001) and chronic CSCR (p = 0.002). A ROC curve showed that for LCN2 serum levels, the 80-ng/ml cutoff value allows to discriminate acute/recurrent CSCR from controls with 80.3% sensitivity and 75.8% specificity, and for NGAL/MMP-9 serum levels, a 38-ng/ml cutoff value allows to discriminate acute/recurrent CSCR from controls with 69.6% sensitivity and 80.3% specificity. In both acute and chronic CSCR, low serum LCN2 and NGAL/MMP-9, provide a biological link between the two CSCR forms, and potential susceptibility to oxidative stress and innate immune dysregulation in CSCR.

Ocular manifestation as first sign of Coronavirus Disease 2019 (COVID-19): Interest of telemedicine during the pandemic context.

We report here the case of a 27-year-old man who consulted by telemedicine during the Coronavirus disease 2019 (COVID-19) pandemic, due to foreign body sensation and left eye redness. Examination revealed unilateral eyelid edema and moderate conjunctival hyperemia. A few hours later, the patient experienced intense headache and developed fever, cough and severe dyspnea. A nasopharyngeal swab proved positive for SARS-CoV-2. This case demonstrates that conjunctivitis can be the inaugural manifestation of the COVID-19 infection. It illustrates the interest of telemedicine in ophthalmology during the COVID-19 pandemic, since moderate conjunctival hyperemia can be the first sign of a severe respiratory distress.

[Severe bacterial keratitis referred to ophthalmology emergency departments: a retrospective study of 268 cases]. / Kératites bactériennes sévères reçues aux urgences ophtalmologiques: analyse rétrospective de 268 cas.

PURPOSE: To investigate epidemiological, microbiological and clinical aspects of severe bacterial keratitis, in order to update current understanding of risk factors (RF) and prognosis. PATIENTS AND METHODS: We conducted a monocentric retrospective study from January 2005 to January 2011, identifying and collecting data from inpatients admitted for severe documented bacterial keratitis. RESULTS: We found 268 unilateral corneal ulcers. At least one local or systemic risk factor was identified in 255/268 patients (95%). The leading risk factor was contact lens wear (129/268), followed by underlying corneal disease (50/268) and prior corneal surgery (47/268). Initial and final visual acuities were 0.06 and 0.2 (1.20 and 0.72 LogMAR) respectively. Contact lens wear was associated with better prognosis and shorter hospitalization (P<0.05). Corneal healing was obtained in 255/268 patients (95%), with adjuvant surgery for 33 patients. The most frequently isolated pathogens were Gram+ cocci, more commonly associated with degenerative keratopathy or prior corneal surgery, and Gram- bacilli, more commonly associated with contact lenses (P<0.05). Both demonstrated a similar prognosis. CONCLUSION: Specific risk factors should be investigated in cases of severe bacterial keratitis. Contact lens wear is the most frequent risk factor, but with a better prognosis than underlying corneal disease, prior corneal surgery or systemic risk factors. The specific bacterial pathogen no longer appears to dramatically influence the outcome of severe corneal ulcers.