BACKGROUND: Toxic/nutritional optic neuropathy (TON) is a diagnosis of exclusion after an extensive work-up. In cases of a non-contributory history or atypical presentation, formal diagnosis can sometimes be difficult an...BACKGROUND: Toxic/nutritional optic neuropathy (TON) is a diagnosis of exclusion after an extensive work-up. In cases of a non-contributory history or atypical presentation, formal diagnosis can sometimes be difficult and delay management. The goal of this study was to evaluate the diagnostic value of checkerboard visual evoked potentials (VEP) for toxic/nutritional optic neuropathy. The working hypothesis was that, in TON, VEPs are more affected than best corrected visual acuity (BCVA). We assumed that, for BCVA ≥ 1/20 and ≥ 2/10, the 60' and 15' checkerboard VEP responses would be respectively affected. METHODS: This was an observational, single-center, retrospective study. We collected demographic data, self-declared data on alcohol and tobacco use, data from the ophthalmologic examination, and notably the BCVA as well as the 60' and 15' VEPs. We divided the subjects into two visual acuity groups, one with BCVA ≥ 1/20, for which we reported the 60' VEP results, and the other with BCVA ≥ 2/10, for which we reported the 15' VEP results. RESULTS: Sixty-five patients were included. For those with BCVA ≥ 1/20, 64.2% of the 60' VEPs were undiscernible from background noise. Similarly, 95.3% of the 15' VEPs were undiscernible for the BCVA ≥ 2/10 group. CONCLUSION: Our study results indicate that, in TON, VEPs are more affected than the visual acuity would suggest. This may be a diagnostic pattern suggestive of TON.
PURPOSE: To characterize childhood non-infectious uveitis (NIU) patients who developed demyelinating lesions during TNF-α blocker therapy and to investigate potential risk factors associated with this pathology. METHODS:...PURPOSE: To characterize childhood non-infectious uveitis (NIU) patients who developed demyelinating lesions during TNF-α blocker therapy and to investigate potential risk factors associated with this pathology. METHODS: This retrospective single-center cohort study included pediatric NIU patients treated with TNF-α blockers who had undergone brain magnetic resonance imaging (MRI) at any time during the course of the disease. Demographic and clinical characteristics, the ocular complication score (OCS), and imaging data were reviewed. RESULTS: The study cohort included 45 patients with a mean age of 13.8±4.46 (5-22) years. The mean duration of TNF-α blocker treatment within the study period was 44±27.9 months. The OCS did not significantly change from baseline to final visit (P=0.10). Brain MRI was performed before initiation of TNF-α blocker therapy in 21 (46.6%) patients and during treatment in 24 (53.4%). All demyelinating lesions were detected on MRIs obtained after TNF-α blocker initiation (median: 52 months; range 18-84). Central nervous system (CNS) demyelinating lesions were identified in 4 (8.8%) patients; two were diagnosed with multiple sclerosis, and two with radiologically isolated syndrome. CONCLUSION: CNS demyelination was uncommon but clinically relevant in pediatric NIU patients receiving TNF-α blockers. Demyelinating lesions may be associated with pars planitis, neurologic symptoms, and/or a family history of demyelinating disease. During treatment, CNS MRI may be considered when new neurologic symptoms accompany an uncontrolled uveitis flare, particularly in the presence of newly developed ocular inflammatory findings.
INTRODUCTION: The goal of this study is to compare the functional outcomes and impact on quality of life of external and endonasal dacryocystorhinostomies using the Lac-Q questionnaire. MATERIAL AND METHODS: This was an...INTRODUCTION: The goal of this study is to compare the functional outcomes and impact on quality of life of external and endonasal dacryocystorhinostomies using the Lac-Q questionnaire. MATERIAL AND METHODS: This was an observational, retrospective, and comparative study conducted at Caen University Hospital between January 2019 and December 2022. Patients who underwent external or endonasal DCR were evaluated using the French translation of the Lac-Q questionnaire, completed between February 2024 and February 2025. Collected data included pre- and postoperative scores for functional and social impact, overall satisfaction, and cosmetic discomfort. RESULTS: Thirty-nine patients were included (29 external, 10 endonasal). Postoperatively, a significant improvement in total score, functional score, and social impact score was observed in both groups (P<0.001). Satisfaction rates were high, and cosmetic concerns were minimal. No statistically significant difference was found between the techniques in terms of score improvement (P=0.175). CONCLUSION: Both external and endonasal DCR significantly improve symptoms and quality of life, with no difference between techniques. Assessment using the Lac-Q allows quantification of this functional and social benefit, complementing traditional anatomical criteria. As both approaches yield comparable results, the choice of technique should be guided by the clinical context and the preferences of both surgeon and patient.
PURPOSE: Benign essential blepharospasm (BEB) is a focal dystonia characterized by involuntary eyelid contractions that can disrupt tear film stability and corneal morphology. Botulinum toxin type A (BTX-A) injection is...PURPOSE: Benign essential blepharospasm (BEB) is a focal dystonia characterized by involuntary eyelid contractions that can disrupt tear film stability and corneal morphology. Botulinum toxin type A (BTX-A) injection is the standard treatment, yet its impact on ocular surface health and corneal epithelial structure remains unclear. This study aimed to assess the effects of periocular BTX-A on tear film parameters and corneal epithelial remodeling using anterior segment optical coherence tomography (AS-OCT). METHODS: This retrospective, single-center study included 35 eyes of 35 BEB patients treated with standardized periocular BTX-A injection (total dose ∼12.5 units). Ocular surface parameters Ocular Surface Disease Index (OSDI), tear breakup time (TBUT), Schirmer test, tear meniscus height (TMH), and meibomian gland dropout were evaluated at baseline and 3 months post-treatment. Corneal epithelial maps obtained via AS-OCT provided central, superior, and inferior epithelial thicknesses and irregularity indices. Corneal power and astigmatism were analyzed by topography. Pre- and post-treatment values were compared using paired tests. RESULTS: At 3 months, blepharospasm severity and OSDI scores improved significantly (P<0.001). TBUT and TMH increased (P<0.001), while Schirmer test and gland dropout were unchanged. Superior epithelial thickness increased and irregularity indices decreased (P<0.001), indicating smoother remodeling. Corneal power and astigmatism decreased significantly (P<0.001), consistent with corneal flattening. No adverse effects were observed. Improvements correlated with reduced spasm severity. CONCLUSION: BTX-A injection in BEB patients alleviates spasms and enhances tear film stability and epithelial regularity. The treatment is safe and well tolerated, offering additional ocular surface benefits beyond motor symptom control.
PURPOSE: To assess diagnostic and clinical decision concordance between a face-to-face ophthalmological examination using handheld equipment and an asynchronous teleophthalmology assessment in disabled elderly fall-risk...PURPOSE: To assess diagnostic and clinical decision concordance between a face-to-face ophthalmological examination using handheld equipment and an asynchronous teleophthalmology assessment in disabled elderly fall-risk patients as well as the feasibility of this approach. PATIENTS AND METHODS: This prospective single-center study evaluated a diagnostic method. Disabled elderly fall-risk patients underwent an in-person ophthalmological examination using a handheld slit-lamp followed by an asynchronous teleophthalmology assessment based on videos acquired by handheld anterior segment and fundus cameras. Diagnostic and management concordance were assessed using Cohen's kappa coefficient. Feasibility was evaluated by the rate of readable examinations. RESULTS: A total of 142 patients (281 eyes) were included. Concordance was very good for phakic/pseudophakic status assessment (kappa=0.87-0.96), moderate for lens assessment (kappa=0.51-0.58) and macular evaluation (kappa=0.48-0.57), and low for other anterior (cornea, iris) and posterior segment (optic nerve head, retinal vessels) assessment as well as for overall clinical decision-making (kappa=0.15-0.35). Feasibility was excellent for anterior segment examination (90-98%) and acceptable for posterior segment assessment (61-81%). A clinical decision could be proposed via teleophthalmology in 50-72% of cases. The main causes of visual impairment were cataract, age-related macular degeneration, and optic neuropathy. CONCLUSION: Asynchronous teleophthalmology using handheld equipment appears feasible in disabled elderly patients, with variable reliability depending on the parameters assessed. Technological, organizational, and methodological improvements are required before broader implementation.
PURPOSE: To evaluate the differences and interchangeability of white-to-white (WTW) distance and anterior chamber depth (ACD) measurements among three devices: Anterion (Heidelberg Engineering, Heidelberg, Germany), IOL...PURPOSE: To evaluate the differences and interchangeability of white-to-white (WTW) distance and anterior chamber depth (ACD) measurements among three devices: Anterion (Heidelberg Engineering, Heidelberg, Germany), IOL Master 700 (Carl Zeiss Meditec, Jena, Germany), and Pentacam (Oculus, Wetzlar, Germany). METHODS: A randomized sample of 275 healthy subjects was selected. Measurements were taken of the right eye of all participants. WTW and ACD were measured using Anterion, Pentacam, and IOL Master 700. Differences between instruments were analyzed using the Friedman test, and device interchangeability was assessed using the Bland-Altman plots. RESULTS: A total of 275 eyes of 275 subjects were evaluated. With regard to WTW analysis, statistically significant differences were found when comparing the three instruments (P<0.001). The highest values were obtained with IOL Master 700, followed by Anterion and Pentacam. For ACD, significant differences were also found among the three devices (P<0.001). The highest ACD measurements were obtained with Anterion, followed by Pentacam and IOL Master 700. CONCLUSION: Significant differences in WTW and ACD measurements were found when comparing the three devices. The clinical relevance of these differences and the interchangeability of the instruments should be individually considered.
OBJECTIVE: The efficacy and safety evaluation of XEN® gel stent implantation, alone and combined with cataract surgery, in glaucoma's surgical treatment, at short- and long-term. MATERIAL AND METHOD: In this single-cente...OBJECTIVE: The efficacy and safety evaluation of XEN® gel stent implantation, alone and combined with cataract surgery, in glaucoma's surgical treatment, at short- and long-term. MATERIAL AND METHOD: In this single-center retrospective study, all patients who received a XEN® gel stent between September 2018 and October 2023 were included. The primary outcome was complete success rate (≥20% decrease in IOP without medication or complication) and qualified success rate (with antiglaucoma treatment or minimal complication) at 1month, 6months, 1year, 2years, 3years and 5years. Needlings were not considered as failures. Secondary endpoints included number of postoperative medications, failures, complications, needlings, visual acuity, RNFL OCT and visual field. RESULTS: One hundred and one eyes of 83 patients were analyzed (41 XEN® single, 60 combined with cataract surgery). Complete success rate went from 73.3% at 1month to 33.3% at 5years, and mean IOP from 17.98mmHg to 13.68mmHg at 5years, with a reduction of around 22% (±4.98). Antiglaucoma medications decreased significantly at all times, from 3 (±0.989 95% CI [0.870-1.149]) classes before surgery to 1 (±1.328 95% CI [0.997-1.991]) class at 5years. Needling was needed in 38.9% cases. Among the 22 failures, ten eyes required trabeculectomy to control IOP, and one case of endophthalmitis was noted. CONCLUSION: XEN®, alone or in combination, provides effective, long-lasting IOP and medication reduction up to 5years, with a good safety profile, in glaucoma's treatment. However, needling is often necessary, and efficacy seems to decrease over time, so, a close postoperative follow-up is required.
PURPOSE: To describe the current challenges in the management of bilateral blindness in southern Togo in the population aged 50 years and over. PATIENTS AND METHODS: This was a standardized descriptive cross-sectional su...PURPOSE: To describe the current challenges in the management of bilateral blindness in southern Togo in the population aged 50 years and over. PATIENTS AND METHODS: This was a standardized descriptive cross-sectional survey in clusters based on the size of the population carried out from September 2 to 26, 2024, following the rapid assessment of avoidable blindness (RAAB) version 7, or RAAB7, methodology of the London School of Hygiene and Tropical Medicine (LSHTM) in subjects aged 50 years and over in southern Togo. Each person aged 50 years or over residing in the locality who gave informed consent underwent measurement of distance visual acuity and an interview on the barriers to treating blindness. RESULTS: In total, 3726 people were examined out of 3850 planned, corresponding to a participation rate of 96.8%. Bilateral blindness was observed in 133 people, composed of 95 women and 38 men, representing a prevalence rate of bilateral blindness of 3.6% with a sex-ratio of 0.4. The 2 main causes of bilateral blindness were cataract in 61.7% and glaucoma in 15.8%. The main barriers to cataract surgery were cost in 31.8%, fear in 22.7%, ignorance of the existence of effective treatment in 17.3%, and difficulty in accessing surgery in 10.9%. CONCLUSION: Cataract remains the leading cause of bilateral blindness, which remains a major public health challenge in southern Togo. The challenges are financial, psychological and infrastructural. Increased action is necessary to reduce the extent of avoidable blindness in southern Togo.