Persistent visual impairment in multiple sclerosis: prevalence, mechanisms and resulting disability.

OBJECTIVE: The objective of this article is to evaluate in multiple sclerosis (MS) patients the prevalence of persistent complaints of visual disturbances and the mechanisms and resulting functional disability of persistent visual complaints (PVCs). METHODS: Firstly, the prevalence of PVCs was calculated in 303 MS patients. MS-related data of patients with or without PVCs were compared. Secondly, 70 patients with PVCs performed an extensive neuro-ophthalmologic assessment and a vision-related quality of life questionnaire, the National Eye Institute Visual Functionary Questionnaire (NEI-VFQ-25). RESULTS: PVCs were reported in 105 MS patients (34.6%). Patients with PVCs had more frequently primary progressive MS (30.5% vs 13.6%) and more neuro-ophthalmologic relapses (1.97 vs 1.36) than patients without PVCs. In the mechanisms/disability study, an afferent visual and an ocular-motor pathways dysfunction were respectively diagnosed in 41 and 59 patients, mostly related to bilateral optic neuropathy and bilateral internuclear ophthalmoplegia. The NEI-VFQ 25 score was poor and significantly correlated with the number of impaired neuro-ophthalmologic tests. CONCLUSION: Our study emphasizes the high prevalence of PVC in MS patients. Regarding the nature of neuro-ophthalmologic deficit, our results suggest that persistent optic neuropathy, as part of the progressive evolution of the disease, is not rare. We also demonstrate that isolated ocular motor dysfunctions induce visual disability in daily life.

Bacterial contamination rate of the anterior chamber during cataract surgery using conventional culture and eubacterial PCR.

PURPOSE: To evaluate the incidence of anterior chamber bacterial contamination during phacoemulsification cataract surgery using eubacterial polymerase chain reaction and conventional cultures. METHODS: This prospective study included 30 eyes of 24 patients who had phacoemulsification with implantation of a foldable acrylic posterior chamber intraocular lens through a 3.2-mm clear corneal incision. Topical aminosid was administered 3 days before surgery. After povidone-iodine antisepsis, 2 intraoperative anterior chamber aspirates were obtained from each patient, the first taken upon entering the anterior chamber and the second at the conclusion of surgery after the suture. Broad-range eubacterial polymerase chain reaction amplification and conventional cultures were used to verify that aqueous humor did not contain any detectable bacteria at the beginning of the surgery and to evaluate the bacterial contamination rate of the anterior chamber at the end of it. No oral antibiotic prophylaxis was used. RESULTS AND CONCLUSIONS: No specimens (0%) aspirated on entry into the anterior chamber or obtained at the conclusion of surgery were positive for microorganisms on culture or eubacterial polymerase chain reaction. None of the eyes developed acute endophthalmitis. The incidence of anterior chamber bacterial contamination during phacoemulsification recovered in this study using eubacterial polymerase chain reaction and conventional culture was null (0%).