[Impact of the French 2020 COVID-19 lockdown on the treatment and follow-up of patients with exudative age-related macular degeneration]. / Impact du confinement français en 2020 sur la prise en charge des patients atteints de dégénérescence maculaire liée à l'âge exsudative.

PURPOSE: To assess the impact of the measures taken during the lockdown period from March 17 to May 11, 2020 on the management of patients with exudative age related macular degeneration treated by intravitreal anti-VEGF injections at the University Hospital of Tours. METHODS: In this retrospective study, patients were included after analysis of the computerized medical records of patients with age related macular degeneration. Those who were treated for exudative age related macular degeneration who received at least 1 intravitreal injection in the 12 months prior and at least one consultation in the 6 months prior to the lockdown period, were included. The initial and final mean visual acuity were compared with a 5 letter non-inferiority margin. A subgroup analysis was performed according to outcomes. The visual acuities immediately after this period were also recorded. RESULTS: In all, 595 eyes of 493 patients were included. The mean initial visual acuity was 59.6 letters, vs. 58.5 for the final visual acuity, i.e. a difference of -1.13 letters with a lower limit of the confidence interval of less than 5. The visual acuity on release from lockdown was comparable to the other 2 measurements. Initial visual acuity and the number of missed treatments were the main factors associated with functional loss. CONCLUSION: Patients' visual acuity during the lockdown period was able to be maintained despite the restrictive measures and limitation of care access in France. The most common cause of substantial visual decline was missed intravitreal injections.

Manifestations of pseudoxanthoma elasticum in childhood.

BACKGROUND: Pseudoxanthoma elasticum (PXE) affects the skin, retina and cardiovascular system. Most cases are related to mutations in the ABCC6 gene. The diagnosis is most often made late in the second or third decade of life. OBJECTIVES: To describe the manifestations of PXE before the age of 15 years. METHODS: Children under age 15 years with definite PXE were evaluated at a PXE referral centre, as were adult patients in whom serious manifestations of PXE had occurred before the age of 15 years. RESULTS: Our series included 96 patients; 15 (16%) had paediatric onset of the disease. Nine children were diagnosed at a mean age of 10 years, a mean of 2.5 years after the presenting symptoms. Cutaneous lesions were the presenting symptoms in eight. None had cardiovascular or ophthalmological symptoms. Six adult patients had had severe cutaneous and/or cardiovascular manifestations before the age of 15 years. Both adult patients with early extensive skin lesions had the PXE-like condition related to the GGCX gene. No ocular symptoms were recorded during childhood. CONCLUSIONS: Cutaneous manifestations of PXE are the same in children as in young adults. Absence of complications is common in childhood, but severe complications are unpredictable. The frequency of complications was retrospectively estimated to be 7% in the adults of our series, although this figure was probably an overestimate because of the recruitment bias in a referral centre. It is, however, important to consider PXE in the paediatric setting, as early diagnosis may be important to provide accurate information and discuss lifestyle adjustments in order to improve the prognosis of the disease.

Establishment of IPC 227 cells as human xenografts in rabbits: a model of uveal melanoma.

This study was designed in order to evaluate the feasibility of establishing an animal model of human uveal melanoma. IPC227, a cell line established from the biopsy of a patient with a spindle cell ciliary body melanoma, was transplanted into the anterior chamber of the eye in immunosuppressed New Zealand rabbits. In a second step, a tumour fragment from the anterior chamber was implanted transclerally into the posterior choroid. Complete ophthalmological examinations were then performed on the animals. Characteristic growth patterns were noted depending on the location of implantation. In the anterior chamber, diffuse, flat, heavily pigmented tumours appeared 8 days after the injection of the cell suspension that covered the iris and the angle by day 25, with a success rate of 100%. Nodular, lightly pigmented tumours were obtained 6-7 weeks after subchoroidal implantation, with a 25% success rate. Clinical examination, including fundus photography, ultrasound and magnetic resonance imaging, demonstrated the same characteristics as those of human uveal melanoma, confirming the value of this model for the evaluation of new therapeutic and diagnostic methods in the management of uveal melanoma.

[Treatment of post-traumatic cyclodialysis using by direct cyclopexy]. / Traitement des cyclodialyses post-traumatiques par cyclopexie directe.

INTRODUCTION: We report 2 cases of posttraumatic cyclodialysis treated by direct cyclopexy. We decided to operate because of the presence of a macular and disc oedema after an ocular chronic hypotony. PATIENTS: The case was a blunt ocular trauma and the other case a perforating injury. For the latter, a cycloplegic treatment was ineffective. The ocular hypotony persisted 2 months in the first case and 2 and a half years in the second. In both cases, the hypotony was major (0mmHg) and the cyclodialysis cleft was extended to 90 degrees (in the superior temporal quadrant and the inferior nasal quadrant). A direct cyclopexy was performed with cilioscleral sutures with 10-0 monofilament. RESULTS: One patient presented a moderate and temporary postoperative hypertony. The maximal follow-up was 9 months: ocular tonus was normalized (10 and 11mmHg), the fundus aspect was improved, and visual acuity was either the same (hand movement perception) or increased from 0.1, 14 to 1.0, 2 on the Parinaud scale. DISCUSSION: The direct cyclopexy was effective in both cases. It precisely defined the cyclodialysis limits, it allowed the suprachoroïdal fluid to drain and restored the anatomic features. Moreover, it allowed treating larger cyclodialysis for which a simple laser treatment would be incomplete. On the other hand, it was invasive intraocular surgery which presented risks of hemorrhage, infection and retinal detachment. CONCLUSION: The direct cyclopexy is an advisable method in the treatment of cyclodialysis. It normalized an ocular tonus and improved of hypotonus retinopathy. However, vision remained sometimes limited because of the posttraumatic sequels are or ocular hypotony that was too lengthy.

[Bacterial contamination of eyedrops in clinical use]. / Etude de la contamination bactérienne de collyres en usage clinique.

PURPOSE: The aim of this study is to assess the importance of bacterial contamination of multidose eyedrops in a routine clinical setting. MATERIAL AND METHODS: 406 eyedrop vials were cultured about one week after clinical use: 204 collected from an Ophthalmic Department, and 202 from a Nursing Home. The microbiological analysis was performed on the tip and the residual eyedrop, counting the number of bacterial colonies. RESULTS: 66 (16.3%) from the 406 analyzed vials were contaminated, and 5.4% out of these were severely affected. There was no significant difference between the "Ophthalmic Department" and the "Nursing Home". Commensal germs were the most frequently encountered in both groups. 4 gram negative organisms were isolated from the "Nursing Home" group. CONCLUSION: These results are in agreement with the literature. Comparison between our two groups is difficult because the eyedrops and uses were different. However, we notice the presence of gram negative organisms in the "Nursing Home". These severe contaminations due to opportunistic pathogen organisms are rare (0.75%), probably underestimated, and represent a real infectious risk during instillation. The study of the contamination site shows that the eyedrop is more often contaminated than the tip. This can be in relation to germ desicsation and to an aspiration phenomenon of contaminated fluid at the tip level. At last, the role of preservatives is not sufficient to ensure the sterility of multidose eyedrops during their use, and this justifies safer (single dose or filtration system) eyedrop vials.

[Definitive internal tamponade with silicone oil in certain cases of retinal detachment]. / Tamponnement interne définitif par huile de silicone dans certains cas de décollement de rétine.

PURPOSE: The aim of this study was to analyze the effect of definitively maintaining silicone oil in the treatment of certain cases of retinal detachment. MATERIAL AND METHODS: Sixteen cases of retinal detachment seen from July 1995 to April 1999 were retrospectively studied. For these eyes with residual visual acuity, we voluntarily maintained silicone oil. There were 11 men and 5 women, mean age 56 (range 24 - 82). Followup ranged from 18 to 45 months. RESULTS: We analyzed visual acuity outcome, complications, and main reasons for maintaining longterm silicone oil CONCLUSION: This study provided interesting insight concerning certain clinical situations where silicone oil has to be maintained definitively. In some cases, low, but useful, visual acuity can be achieved for long periods of time. This therapeutic approach would be particularly helpful for mono-ophthalmic patients.

[Acquired nystagmus in a 12-year-old boy as initial presentation of Lyme disease]. / Nystagmus acquis, révélateur d'une maladie de Lyme chez un enfant de 12 ans.

We report the case of a 12-year-old boy presenting with acquired horizontal nystagmus, headaches, and vertigo. CT, MRI, viral tests, and the Lyme disease test were at first negative. We made the diagnosis of neuroborreliosis based on a repeated Lyme disease test and lumbar puncture revealing intrathecal synthesis of specific antibodies. Adjusted antibiotic treatment led to complete disappearance of symptoms. Lyme borreliosis is difficult to diagnose and should be sought in case of unusual neuro-ophthalmic signs, especially in children.

[Retinal lesions in pseudoxanthoma elasticum: 51 patients]. / Lésions rétiniennes dans le pseudoxanthome élastique : 51 cas.

OBJECTIVE: Description of retinal lesions in patients with pseudoxanthoma elasticum (PXE). PATIENTS AND METHODS: This cross sectional study evaluated 51 consecutive patients (31 women and 20 men, mean age, 47 years±16) from June 2008 to September 2010. Clinical and fundoscopic evaluations were performed for each patient with fundus images: colour, red-free, autofluorescence of the central retina, and red-free of the retinal periphery. Several patients were examined with fluorescein angiography, indocyanine green angiography, or optical coherence tomography when neovascular complications were suspected. RESULTS: In addition to classical angioid streaks and "peau d'orange" aspects, we identified several other retinal lesions: pattern dystrophy, drusen of the optic nerve, peripheral "comet tail" lesions, subretinal fibrosis, and autofluorescent perimacular white spots, suggesting atrophy of the pigmented epithelium overlying the "peau d'orange" lesions, which appeared earlier, with onset subsequently followed by angioid streaks. The incidence of "peau d'orange" decreased with age. Subretinal fibrosis and pattern dystrophy of the macula were often associated and occurred around 40 years of age. The risk of neovascular complications increased with age. CONCLUSION: Macular decompensation most often occurring around the age of 50 is a common event in PXE, associated with aging, disappearance of "peau d'orange", changes in angioid streaks, and development of atrophy of the retinal pigment epithelium.