F. Rouberol

Analysis of diluted vitreous samples from vitrectomy is useful in eyes with severe acute postoperative endophthalmitis.

PURPOSE This study was designed to compare the diagnostic yield of microbiological analysis performed on diluted and undiluted vitreous samples from pars plana vitrectomy (PPV) in patients with acute postcataract endophthalmitis. DESIGN Cohort study, evaluation of diagnostic test or technology. PARTICIPANTS Patients with acute postcataract endophthalmitis (<6 weeks). METHODS Undiluted and diluted vitreous samples were taken from 34 consecutive patients at the beginning of PPV as part of the multicenter prospective study of the French Institutional Endophthalmitis Study (FRIENDS) group. Vitrectomy was performed after 1 (n = 12) or 2 (n = 22) intravitreous antibiotic injections. McNemars nonparametric test was used to compare culture and polymerase chain reaction (PCR) results between diluted and undiluted samples. MAIN OUTCOME MEASURES Rate of positivity of conventional culture (brain heart infusion broth) and eubacterial PCR tests from undiluted and diluted vitreous samples. RESULTS The microbiological analysis of both undiluted and diluted vitreous samples detected and identified a bacterial pathogen in 26 out of 34 cases (76.4%). The analysis of undiluted and diluted vitreous at the time of PPV, using eubacterial PCR and conventional culture, gave similar results (P = 0.99; McNemar test). However, eubacterial PCR was more sensitive than culture in detecting bacteria in vitreous at the time of PPV (76% vs 6%; P = 0.001; McNemar test). The difference in sensitivity between the 2 techniques was primarily associated with false-negative culture results for undiluted samples (2/3 of cases), mainly for coagulase-negative staphylococci. CONCLUSIONS The microbiological results obtained combining PCR and culture techniques were similar for diluted vitreous and undiluted vitreous analysis. When eubacterial PCR is available, sampling diluted vitreous, an easier procedure, may replace sampling undiluted vitreous.

Comparative study of 50 early- or late-onset retinal detachments after open or closed globe injury.

Purpose: To compare initial findings and final prognosis of retinal detachments (RDs) secondary to open or closed ocular injuries. Methods: This prospective study comprised 50 consecutive patients with open (n = 25, with initial successful repair) or closed (n = 25) globe injuries during a 3-year period (2004-2007), with follow-up of at least 6 months (10.1 ± 5.8 months). The most common surgical procedure (76%) was pars plana vitrectomy. Results: Clinical findings were similar in both groups for RD location and extent, frequency of macular involvement, number and nature of tears, and grade of proliferative vitreoretinopathy. Retinal detachment secondary to open/closed globe injury differed significantly, with longer time to onset after trauma, lower frequency in children, and higher rate of aphakia. Final anatomical and functional prognosis and rate of RD recurrence (25%) were similar in both groups. Good final visual prognosis (≥20/40) was significantly associated with initial visual acuity >20/200 and macula-on RD. Definitive redetachments (n = 3) were related to history of posttrauma endophthalmitis, posterior intraocular foreign body, or severe proliferative vitreoretinopathy. Conclusion: Final prognosis was similar in eyes with RD secondary to open and closed globe injuries. The surgical technique depended mainly on lens status, type of retinal tear (dialysis and giant retinal tear), and the presence of preoperative proliferative vitreoretinopathy. Final prognosis (visual acuity ≥20/40) was associated with initial visual acuity >20/200 and macula-on status.

Comparative prospective study of rhegmatogenous retinal detachments in phakic or pseudophakic patients with high myopia.

Purpose: To compare the anatomical and functional results of primary rhegmatogenous retinal detachment in highly myopic phakic or pseudophakic eyes. Methods: This prospective 2-center study included 191 consecutive eyes (151 phakic and 40 pseudophakic eyes) from a prospective cohort of 835 patients (IRB #5891, between 2004 and 2008). Baseline and follow-up data were systematically recorded at presentation, 1 month, and 6 months or more after surgery. On final examination, two groups were considered based on the need for one or more surgeries to achieve retinal reapplication. End points were primary reattachment rate at the 6-month visit, final anatomical success rate, postoperative visual acuity, and intraoperative and postoperative complications. Results: Pseudophakic eyes differed from phakic eyes in age (60.8 ± 10.4 vs. 49.9 ± 12.3, P < 0.001), smaller pupil dilation (8.0 ± 1.5 vs. 8.5 ± 1.2 mm, P = 0.02), fewer retinal tears seen preoperatively (1.5 ± 1.6 vs. 2.2 ± 2.2, P = 0.06), more frequent use of pars plana vitrectomy (80% vs. 28.5%, P < 0.001), and higher single reattachment rate (92.5% vs. 80.7%). Visual acuity was greater than or equal to 20/40 in 54% of cases with single retinal detachment surgery and 44% of cases with multiple surgeries. Multiple logistic regression analysis showed that only 3 independent variables were significantly predictive of good final visual acuity (20/40): initial visual acuity (<20/400, odds ratio = 0.19; 95% confidence interval, 0.07–0.51; P = 0.002), axial length (odds ratio = 0.57; 95% confidence interval, 0.44–0.75, P < 0.001), and pars plana vitrectomy (odds ratio = 0.33; 95% confidence interval, 0.15–0.71, P = 0.004). Conclusion: This prospective study showed similar baseline retinal detachment characteristics of high myopic phakic or pseudophakic eyes, suggesting that high myopia was the main pathogenic factor in both groups. Although high myopic eye presents anatomical characteristics that could favor surgical morbidity, these recent prospective data show that high myopic eyes exhibit functional and anatomical prognosis close to that described in emmetropic eyes.

Occurrence and risk factors for retinal detachment after pars plana vitrectomy in acute postcataract bacterial endophthalmitis

Background/aims To report the incidence, risk factors and prognosis of retinal detachment (RD) in patients who had vitrectomy for acute bacterial endophthalmitis after cataract surgery. Methods 123 patients with acute postcataract endophthalmitis, consecutively treated with pars plana vitrectomy (PPV) were included by the French Institutional Endophthalmitis Study group, in a prospective multicentre cohort study. Risk factors of RD were analysed using logistic regression. Results At the 6-month follow-up, the rate of post-PPV RD was 13% (n=16). The risk factors of post-PPV RD were diabetes (OR=4.7 (1.4–15.4), p=0.01) and visualisation of retinal vasculitis on the posterior pole (OR=3.8 (1.1–13.9), p=0.03) at the time of PPV. Postoperative RD occurred in 56% (n=9) of cases in the first month, in 31% (n=5) in the second month and in 6% (n=1) in the third month, with a mean delay of 47±71 days after PPV. The macula was detached in 12 cases (75%) and proliferative vitreoretinopathy grade C was present in seven cases. Final successful reattachment of the retina was obtained in 60% (n=9/15) of cases, with one (7/9) or two surgeries (2/9). Final visual acuity after surgical repair was ≥20/40 in 19% of cases, compared with 43% in patients without RD (p=0.05). Conclusions RD is a major and severe complication of PPV performed in patients with acute postcataract endophthalmitis. Retinal vasculitis is a major risk factor of RD after PPV. Anatomical and functional outcome remain poor.

Étude prospective de 34 décollements de rétine par déchirure géante

PURPOSE To report the anatomical and functional outcomes of vitrectomy with silicone oil tamponade in the treatment of retinal detachment associated with giant retinal tears due to various factors. METHODS We prospectively followed 34 eyes of 33 patients with giant retinal tear. That underwent vitrectomy, injection of perfluorocarbon liquids and silicone oil tamponade. Scleral buckle was associated with vitrectomy in cases of inferior giant retinal tear; 26,5 % and 11,8 %, respectively, demonstrated pseudophakia and aphakia. Seven eyes (20,5 %) had a history of trauma (blunt injuries in four and a penetrating injury in three) and, 14 eyes (41,2 %) had severe myopia. One patient developed a bilateral giant retinal tear during the follow-up. RESULTS Retinal attachment was obtained in 33 (97 %) of 34 eyes, with a mean follow-up of 14,5+/-6 months. Retinal detachment reoccurred in four eyes (11,6 %) under silicone oil, in one eye (2,9 %) during the silicone removal, and in two eyes (5,8 %) after silicone removal and cataract surgery. Silicone oil was removed from all eyes (4,3+/-1 months). The most frequent postoperative complication was cataract in ten of 18 phakic eyes (55,5 %). Functional success with visual acuity 0,4 or better was obtained in 18 cases (52,96 %). CONCLUSION Pars plana vitrectomy with silicone oil tamponade proved to be highly effective in giant retinal tears in terms of the anatomical and functional results. The analysis of recurrent retinal detachment allowed us to refine the technique and to suggest scleral buckle in one case of inferior retinal tear with laser over 360 degrees .

Longitudinal study of retinal status using optical coherence tomography after acute onset endophthalmitis following cataract surgery

Purpose To analyse the macula imaged with optical coherence tomography (OCT) in patients treated for acute postcataract endophthalmitis. Methods Patients presenting with acute postcataract endophthalmitis were included in this observational and multicentre study from January 2008 to December 2011. We recorded the following OCT data at the 3, 6 and 12-month visits: the central macular thickness, the perifoveal macular thickness, the central foveal point thickness and abnormalities of the outer retina, the macula and vitreoretinal interface. Results 46 patients were included in the OCT analysis. From month 3 to 12, epiretinal membrane (ERM) prevalence increased from 26% to 39%, vitreomacular traction prevalence decreased from 12% to 6%, non-tractional macular oedema (ME) prevalence varied between 7% and 13%. Only macular thinning remained stable at 10%. At month 12, a significant correlation was found between non-tractional ME and capsular rupture (at the time of cataract extraction, p=0.03). Eyes with an ERM exhibited increased central macular thickness (p=0.001) and lower visual acuity (VA) (p=0.02) at M12 in comparison to the group with normal macula. OCT analysis showed a significant association between ERM and the alteration of the ellipsoid band (p=0.02), as well as the external limiting membrane (ELM, p=0.07) at M12. Conclusions ERM and ME were the main macular abnormalities diagnosed after 1 year of follow-up, associated with VA less than or equal to 20/40 in 50% of the cases. Ultrastructural abnormalities of the ELM and the ellipsoid band were frequently observed in those patients.

Anatomical and visual outcome after pars plana vitrectomy in acute postcataract endophthalmitis

Purpose To report visual and anatomical outcome of patients vitrectomized for acute post bacterial endophthalmitis Methods 123 patients with acute postcataract endophthalmitis and consecutively treated by pars plana vitrectomy (PPV) were included in four academic hospitals (French Institutional Endophthalmitis Study (FRIENDS) group). Results At 6 month follow-up, 49 patients (40%) had a visual acuity (VA) greater than or equal to 20/40, and 83 patients (68%) had VA greater than or equal to 20/200. Baseline factors associated with final VA ≥20/40 were a younger age (Odds ratio, OR= 1.05 (1.05-1.09), p=0.006), presence of fundus visibility (OR=7 (1,4-34,6),p=0.007), and absence of cataract surgery complications (OR=15.3 (1.9-32), p=0.001), corneal edema (OR= 2.3 (1.1-4.9), p= 0.02), hypopion (OR= 2.6 (1.1-6.6), p=0.04), or of virulent bacteria (OR=3.1 (1.4-6.7), p=0.005). At the time of PPV, absence of vasculitis at the posterior pole at the time of PPV (OR= 7 (1.4-34.6), p=0.02) and a lower duration of PPV (OR=1.02 (1.01-1.04), p=0.02) were significantly associated with final VA ≥20/40. Risk factors of RD were diabetes (OR = 4.7 (1.4-15.4), p=0.01), and visualization of retinal vasculitis on the posterior pole (OR = 3.8 (1.1-13.9), p= 0.03) at the time of PPV. Conclusion PPV allowed to be beneficial in a majority of the patients. Baseline inflammatory signs and bacterial virulence are the main prognostic visual factors. RD remains the major complication but final anatomical and visual outcome is still poor, despite updated vitreoretinal techniques

143 - Spécificité de la sérologie Borrelia dans le cadre du bilan étiologique des uvéites sévères.

Objectif Rapporter la faible specificite de la serologie Borrelia, de la maladie de Lyme, dans le bilan etiologique des uveites severes. Materiels et Methodes Etude retrospective des cas de serologies Borrelioses positives retrouves dans le bilan etiologique des uveites severes diagnostiqueesaux urgences ophtalmologiques et hospitalises dans le service d’ophtalmologie de l’hopital Edouard Herriot de Lyon entre les mois de Novembre 2007 et Novembre 2008. Resultats Sur cette periode, 6 cas de serologies Borrelioses positives ont ete recenses lors de bilan etiologique d’uveites severes se presentant aux urgences. La serologie Borrelia etait positive en IgG dans 3 cas. Elle etait positive en IgM dans les 3 autres cas. Dans tous les cas, le Western Blot etait retrouve positif soit pour les IgG soit en IgM. Cependant, l’etiologie finalement retenue n’etait jamais en rapport avec la maladie de Lyme (syphilis, lymphome, necrose virale, neovaisseaux choroidiens idiopathique, toxoplasmose, pars planite). Discussion L’interet de la serologie Borreliose de la maladie de Lyme est limite en l’absence d’elements anamnestiques evocateurs (origine geographique, piqure de tiques, erytheme chronique migrant, arthralgie, paralysie faciale) du fait de sa faible specificite. Conclusion La specificite de la serologie Borrelia etant limitee, les resultats de cet examen sont a interpreter avec circonspection au cours de la demarche diagnostique. Sa place dans la recherche etiologique des uveites doit donc etre relativisee et sa demande cliniquement justifiee.

047 Angéite givrée sur primo-infection à EBV

Introduction Nous presentons un cas d’angeite givree chez un jeune garcon en bonne sante dont un bilan exhaustif a revele une primo-infection a Epstein Barr virus. L’angeite givree est une pathologie rare, notre cas est le premier decrit dans la litterature en France, et c’est la premiere fois que le virus Epstein Barr a ete incrimine de facon formelle. Materiels et Methodes Un garcon s’est presente en urgence pour une baisse de l’acuite visuelle. L’examen objectivait, de facon bilaterale, un decollement sereux retinien du pole posterieur associe a un engainement blanchâtre des vaisseaux retiniens. L’aspect etait typique de l’angeite givree, nous avons alors realise un large bilan etiologique. Resultats Le bilan a revele une primo-infection a Epstein Barr virus, confirmee par la PCR sur le sang. Un traitement par bolus de corticoides avec relais « per os » a doses degressives a permis une resolution des troubles. Discussion L’angeite givree est frequemment associee a des prodromes viraux, avec dans 1/3 des cas une serologie positive pour un agent infectieux. Une hypothese a ete emise de reaction d’hypersensibilite avec depots de complexes immuns perivasculaires. On a pu observer un aspect de vascularite comparable lors de diverses pathologies retiniennes infectieuses, auto-immunes, et lors d’hemopathies malignes avec infiltration lymphomateuse. Conclusion Ce cas correspond a la description initiale de l’angeite givree dite idiopatique. Un bilan complet a identifie une infection par le virus d’Epstein Barr chez le patient. Cela permet de penser que l’angeite givree pourrait etre toujours reliee par un mecanisme immunologique a une pathologie infectieuse.

045 Syndrome de traction vitréo-maculaire bilatéral et sarcoïdose : à propos d’un cas

Introduction Le syndrome de traction vitreo-maculaire est la traduction de modifications retiniennes induites par un decollement incomplet du vitre posterieur au niveau de la macula et de la papille. Materiels et Methodes Nous rapportons le cas d’une femme de 72 ans, traitee par prednisone pour une sarcoidose renale, pulmonaire et oculaire depuis 2 ans, dont l’acuite visuelle a progressivement diminue en l’espace de quelques mois. Il existait au fond d’œil, confirme par l’OCT, un syndrome de traction vitreo-maculaire bilateral, complique d’un decollement de retine mixte a droite. Discussion Nous insisterons sur la definition clinique et para-clinique du syndrome de traction vitreo-maculaire, en soulignant l’importance de l’OCT. Nous discuterons de sa prise en charge chirurgicale. Enfin, nous essaierons d’envisager des hypotheses quant a son developpement bilateral et simultane dans ce contexte de sarcoidose. Conclusion Le syndrome de traction vitreo-maculaire n’est classiquement pas decrit parmi les complications retiniennes de la sarcoidose. La vitrectomie posterieure associee a un pelage de la hyaloide posterieure reste le traitement de reference dans cette pathologie.