[Epidemiological aspects of keratoconus in children]. / Aspects épidémiologiques du kératocône chez l'enfant.

PURPOSE: To study the epidemiological aspects of keratoconus in children. METHODS: We conducted a retrospective study of patients with keratoconus diagnosed prior to age 15 or after age 27. Age, gender, reason for consultation, ethnicity, personal and family history, allergic history, eye rubbing, optical and surgical treatment, and educational and professional background were identified. Data from each group were compared by Chi(2) testing. RESULTS: Forty-nine children and 167 adults were studied. The majority of patients were Caucasian. Children were more frequently male (P=0.0386) and allergic (67.35% versus 47.31% in adults, P=0.0136). Eye rubbing was found in 91.84% of children and 70.06% of adults (P=0.002). In total, 12.24% of children had a family history of keratoconus versus 14.97% of adults (P=0.6324). Totally, 68.09% of children were fitted with rigid contact lenses versus 15.66% of adults (P=0.0909). In all, 80.5% of surgically treated children underwent corneal collagen cross-linking versus 30% of adults. DISCUSSION: Younger patients are more often male, with women being older at time of diagnosis. Allergy is a frequent association. However, 25% of children in the general population display allergies. In any event, eye rubbing is a common feature, whether due to itching or induced ametropia. CONCLUSION: In order to detect the disease early, corneal topography could be performed routinely in all young, allergic boys with a history of eye rubbing and recent-onset corneal astigmatism.

[Decreased visual acuity in young patients; Javal's ophthalmometer is still contributing]. / Baisse de l'acuité visuelle du sujet jeune ; l'ophtalmomètre de Javal est toujours contributif.

PURPOSE: The purpose of this study was to recall the advantages of the Javal ophthalmometer in screening keratoconus. PATIENTS AND METHODS: In three young patients with progressive visual loss, optic neuropathy was strongly suspected by their ophthalmologist despite a strictly normal neuro-ophthalmology record. The patients underwent an ophthalmic clinical examination at the Bordeaux University Hospital, which guided the paraclinical examination with corneal videotopography (Orbscan II(®), Bausch and Lomb) and the biomechanical properties of the cornea with the ocular response analyzer (ORA(®), Reichert). RESULTS: Visual acuity improved in all patients on the pinhole visual acuity test. The videotopography concluded in keratoconus in all three patients. The biomechanical parameters were abnormal. The patients were equipped successfully with hard contact lenses. CONCLUSION: Despite the latest technologies including videotopography and ORA(®), examination of the cornea with the Javal ophthalmometer remains a landmark of the eye examination and can assist in screening some keratoconus conditions and avoiding diagnostic uncertainties as well as inappropriate and expensive paraclinical examinations.

[Metronidazole: alternative treatment for ocular and cutaneous rosacea in the pediatric population]. / Le métronidazole, alternative thérapeutique des rosacées oculaires et cutanées de l'enfant.

OBJECTIVE: To assess the effectiveness and tolerance of systemic metronidazole in the treatment of childhood ocular and cutaneous rosacea. METHOD: Single-center multidisciplinary retrospective study. PATIENTS: Children aged between 1 and 15, with ocular and/or cutaneous rosacea, treated in the pediatric ophthalmology and dermatology department of Bordeaux, France, from January 1996 to September 2009. RESULTS: Eleven patients out of 20 had ocular and cutaneous rosacea, three had ocular symptoms only, and six had cutaneous symptoms only. In 11 patients (55%), the ocular symptoms preceded the skin disease. Meibomian cyst and phlyctenular conjunctivitis were the main symptoms. Keratitis was seen in four patients and lower corneal ulcer in two cases. The papulopustular form was the most frequent dermatologic form. All patients with ocular involvement received first-line treatment of eyelid hygiene. No topical ophthalmic treatment such as corticosteroid or cyclosporine 0.5% or 2% was used. Thirteen patients who showed no improvement despite eyelid treatment, the association of ocular and cutaneous rosacea, severe ocular involvement with keratitis, and severe recurrent cutaneous rosacea were treated orally. Two patients, aged between 12 and 14 years, received treatment with an anti-inflammatory dose of doxycycline for 2 to 3 months and achieved complete remission. One 22-month-old patient received oral treatment with erythromycin at a dose of 250 mg three times daily for 4 months. Ten patients, aged 12 to 64 months, were treated with systemic Metronidazole. Treatment lasting at least 3 months at a dose between 20 and 30 mg/kg per day was necessary to obtain complete and lasting remission. An early cessation of treatment, before 3 months, seems associated with partial remission of the disease and early recurrence. In cases complicated by ocular keratitis and corneal ulcer, prolonged treatment lasting 6 months led to clinical remission. The short courses (3-6 months) were preferred to long-term administration to prevent neurological toxicity. Maintenance therapy was based on eyelid hygiene. No recurrences and no toxic effects were observed at a median of 48 ± 6 months. CONCLUSION: Childhood ocular rosacea is not rare, but is often misdiagnosed. It often precedes skin symptoms but it can remain isolated. Metronidazole could be alternative treatment for ocular and cutaneous rosacea in the pediatric population.

[Detection of keratoconus using wavefront analysis]. / Dépistage aberrométrique du kératocône.

PURPOSE: To determine the value of wavefront analysis in the detection of keratoconus. PATIENTS AND METHODS: A prospective study was conducted from May 2008 to May 2010. Four groups were formed: patients with a "healthy" cornea (group 0; n=48), patients with keratoconus "suspect" (group 1; n=43), patients with keratoconus "forme fruste" (group 2; n=31), and patients with "beginning" keratoconus (group 3; n=47). Total and corneal aberrations were analysed. The Fisher test and Student t-test were used to compare the different groups. Receiver operating characteristic (ROC) curves were plotted when aberration differentiated groups 0 and 1. RESULTS: Total and corneal coma (Z 3), the corneal trefoil, (Z 3) and the corneal secondary astigmatism (Z 4) differentiated groups 0 and 1. Sensitivities and specificities of total and corneal coma, corneal trefoil, and corneal secondary astigmatism were, respectively, 67.4%, 56.3% (Youden=0.237), 60.5%, 72.9% (Youden=0.334), 83.7%, 39.6% (Youden=0.233), and 65.1%, 58.3% (Youden=0.234). Total, corneal coma, and corneal trefoil differentiated all severity groups. The third high-order aberrations differentiated groups 1 and 2. DISCUSSION: High-order aberrations are good indicators for grading keratoconus. Total high-order aberrations are less discriminating than corneal high-order aberrations. Corneal coma (Z 3) is the most discriminating aberration to differentiate the healthy cornea from the suspect cornea. Nevertheless, it does not optimally detect keratoconus suspect (Youden=0.334 and sensitivity=60.5%). The statistical analysis suggests that keratoconus suspect and forme fruste are different entities. CONCLUSION: Wavefront analysis can be used for the detection of keratoconus suspect, forme fruste, and beginning keratoconus but must be associated with videotopography and pachymetry during consultation of refractive surgery.

[Central toxic keratopathy and fibromyalgia: a case report]. / Kératopathie centrale toxique et fibromyalgie : à propos d'un cas.

INTRODUCTION: A patient with fibromyalgia after laser refractive surgery presented bilateral diffuse lamellar keratitis complicated by central toxic keratopathy. CLINICAL CASE: A 51-year-old patient, followed for fibromyalgia, consulted for visual loss 1 week after laser in situ keratomileusis. Slit lamp examination revealed stromal infiltrate in both eyes into the flap interface. Confocal microscopy showed an infiltration of inflammatory cells into the anterior stroma and the flap interface. Intensive topical corticosteroid treatment was used and the left eye was treated with flap lifting and interface irrigation. The corneal infiltrates decreased very slowly, and the left eye developed postoperative hyperopia. Diagnosis of central toxic keratopathy was discussed. Visual acuity, highly volatile, was limited to 7/10 (right eye) and 6/10 (left eye). CONCLUSION: Diffuse lamellar keratitis (DLK) is a sterile inflammation after laser in situ keratomileusis. Central toxic keratopathy is characterized by noninflammatory central corneal opacification with a significant hyperopic shift. The cause of central toxic keratopathy is unknown. Fibromyalgia is a widespread, chronic pain disorder that includes a complex constellation of somatic and emotional symptoms. Patients often complain of dry eye sensations. Recent studies have highlighted a reduced corneal sensitivity in patients with fibromyalgia. There could be a relation between fibromyalgia, diffuse lamellar keratitis, and central toxic keratopathy. Some precautions may be used before LASIK in patients with fibromyalgia.

[Severe bacterial keratitis and activity of fluoroquinolones]. / Kératites bactériennes sévères et sensibilité des germes aux fluoroquinolones.

AIM: To study the microbiological characteristics of patients with severe bacterial keratitis in Bordeaux, France, as well as the species' resistance to fluoroquinolones. METHODS: We conducted a retrospective study of 57 patients presenting severe bacterial keratitis over 20 months. The positive bacteriological cultures of the corneal smears, bacteria, and the antibiogram were listed. RESULTS: Fifty-seven patients with severe bacterial keratitis were hospitalized from March 2005 to November 2006. Pseudomonas aeruginosa (n=17), Staphylococcus aureus (n=16), and coagulase-negative Staphylococcus (n=10) were the most frequent species. P. aeruginosa was sensitive in 100% of cases to ciprofloxacin, S. aureus was sensitive in 94% of cases to ciprofloxacin, and coagulase-negative Staphylococcus species were sensitive in 100% of cases to ciprofloxacin. No significant different was noted between ciprofloxacin, levofloxacin, and moxifloxacin on the bacteria studied (p>0.05). CONCLUSION: In this study, except for the Streptococcus species, ciprofloxacin was effective against the species responsible for severe bacterial keratitis.