[Vision screening for children: Recommended practices from AFSOP]. / Le dépistage visuel chez l'enfant : les recommandations de l'Association Francophone de Strabologie et d'Ophtalmologie Pédiatrique (AFSOP).

In light of the international literature, a workgroup of experts from the AFSOP met in February 2019 to formulate updated recommendations for visual screening in children. An ophthalmologic examination during the first month of life is recommended for children at risk of developing infantile organic amblyopia. An ophthalmologic examination including cycloplegic refraction between 12 and 15 months of age is recommended for children at risk of developing functional amblyopia. At any age, a prompt ophthalmologic examination is recommended for a child suspected of functional or organic ocular pathology. In children without risk factors or warning signs, a systematic orthoptic screening examination is recommended during the third year of life, including a monocular visual acuity test, a cover-test and a refraction by photoscreener. The child is referred to the ophthalmologist only in the case of an abnormal screening result, according to the following criteria: visual acuity <5/10, or >1 difference between eyes, abnormal cover test, photodetection refraction values <-3D or>+2.5D for the sphere,>1.5D for astigmatism and>1D for anisometropia. Finally, we review normal childhood refractive errors as a function of age as well as the correct use of photo screening devices.

[Intravitreal bevacizumab pretreatment in vitrectomy for severe diabetic retinopathy: a series of six cases]. / Utilisation du bévacizumab (Avastin(®)) en injection intravitréenne avant vitrectomie pour rétinopathie diabétique sévère, à propos de six cas.

INTRODUCTION: Bevacizumab (Avastin(®), Roche) is a full-length humanized monoclonal antibody applicable to all subtypes of vascular endothelial growth factor (VEGF). The purpose of this study was to report the results of its use as a surgical additive in severe cases of proliferative diabetic retinopathy (PDR). PATIENTS AND METHOD: This retrospective study focused on six eyes of six patients with complicated diabetic retinopathy. A vitrectomy was performed within 13.6 days after an intravitreal bevacizumab injection of 0.1 mL (2.5mg), with dissection of the fibrovascular proliferation using a mono- or bimanual delamination technique. RESULTS: The mean follow-up after intravitreal injection was 13.3 months. The mean surgery time was 64 minutes. The bimanual technique was not necessary. Only one iatrogenic retinal tear was repaired. The intraoperative bleeding was negligible. No adverse events resulting from the drug nor recurrence were observed throughout the follow-up period. CONCLUSION: Intravitreal bevacizumab is useful as a surgical additive in severe cases of PDR, significantly improving surgical conditions. Nevertheless, its use beyond approved indications should be reserved for complex surgical cases.

[Pars plana vitrectomy, subretinal injection of recombinant tissue plasminogen activator and fluid-gas exchange in the management of massive submacular hemorrhages secondary to age-related macular degeneration]. / Traitement des hématomes maculaires compliquant la DMLA par vitrectomie, injection sous-rétinienne de rt-PA et tamponnement intraoculaire par gaz.

INTRODUCTION: The natural prognosis of eyes with subretinal hemorrhage resulting from age-related macular degeneration is generally poor. A variety of therapeutic approaches have been developed but no consensus was found. Therefore, we evaluated a technique consisting of pars plana vitrectomy and subretinal rt-PA injection followed by evacuation of the liquid blood using sulfur hexafluoride (SF6). PATIENTS AND METHODS: This study was a retrospective clinical case series examining 18 eyes of 16 patients with age-related macular degeneration and thick submacular hemorrhage treated with vitrectomy, subretinal injection of rt-PA (0.5mg), and fluid-gas exchange. RESULTS: The subretinal hemorrhage was displaced in all 18 cases, revealing a choroidal lesion in 17 eyes. A treatable lesion accountable for the bleeding was identified in ten eyes, which all received a secondary treatment (intravitreal injection or photodynamic therapy). After a mean follow-up of 6 months, the final visual acuity improved in ten eyes. Complications consisted of one case of retinal detachment and one case of hyphema. CONCLUSION: This surgical technique seems useful in displacing thick submacular hemorrhage secondary to age-related macular degeneration, allowing postoperative fluorescein angiography testing and, potentially, subsequent treatments. However, further controlled and multicentric studies will be required to assess its efficacy and safety in the management of this difficult clinical problem.

[Severe bacterial keratitis. A clinical, epidemiologic, and microbiologic study]. / Kératites bactériennes sévères. Etude épidémiologique, clinique et microbiologique.

INTRODUCTION: The aim of this study was to report the epidemiologic and microbiologic features and to define the risk factors of hospitalized cases of bacterial keratitis in the Toulouse University Hospital Center of Ophthalmology (France). METHODS: This was a retrospective study including all cases of serious bacterial keratitis hospitalized between January 2006 and November 2007. Epidemiologic, microbiologic, and clinical factors such as age, reasons for hospitalization, visual loss, and risk factors were described. RESULTS: Sixty-seven patients were hospitalized during this period, with a mean age of 46 years. The two most frequent clinical features for hospitalization were the area of stromal infiltrate (63%) and central corneal localization (61%). A local risk factor was identified in 92.5% of cases in decreasing order: contact lens wear (49%), keratopathy (16%), corneal injury (12%), and corneal surgery (7%). Sixteen percent had immunodeficiency from the most part because of diabetes and Gougerot-Sjögen's syndrome. Bacterial samples were positive in 57% of cases. Gram-negative bacteria were often isolated (45%) among contact lens wearers. After 3 months, the final visual acuity improved in 85% of the eyes studied. DISCUSSION: Contact lens wear, even if it was the leading risk factor of serious bacterial keratitis requiring hospitalization, was not a negative prognosis factor in our study. CONCLUSION: Factors such as a low preoperative visual acuity, age, and the size of the initial infiltrate have a poor prognosis and immunodeficiency is the predisposing factor associated with the worst final visual acuity.

Confirmation of RAX gene involvement in human anophthalmia.

Microphthalmia and anophthalmia are at the severe end of the spectrum of abnormalities in ocular development. Mutations in several genes have been involved in syndromic and non-syndromic anophthalmia. Previously, RAX recessive mutations were implicated in a single patient with right anophthalmia, left microphthalmia and sclerocornea. In this study, we report the findings of novel compound heterozygous RAX mutations in a child with bilateral anophthalmia. Both mutations are located in exon 3. c.664delT is a frameshifting deletion predicted to introduce a premature stop codon (p.Ser222ArgfsX62), and c.909C>G is a nonsense mutation with similar consequences (p.Tyr303X). This is the second report of a patient with anophthalmia caused by RAX mutations. These findings confirm that RAX plays a major role in the early stages of eye development and is involved in human anophthalmia.