Le décollement de rétine (DR) est une pathologie potentiellement cécitante. La rapidité de prise en charge est un facteur pronostique majeur. Nous avons étudié le délai de prise en charge chirurgicale des décollements de rétine et analysé les facteurs pouvant l’influencer.Enquête transversale, multicentrique, réalisée sur 6 mois. Critère principal : délai séparant diagnostic et chirurgie. Critère secondaire : délai séparant premiers signes et chirurgie. Facteurs étudiés : les caractéristiques sociodémographiques et cliniques, la distance domicile/centre chirurgical et présence d’un week-end.Nous avons inclus 159 patients. Le délai moyen diagnostic-chirurgie était de 4,4 jours ± 12,3 (2,7 ± 4,3 pour les DR < 1 mois, dits récents) et était allongé par la présence d’un week-end (p < 0,001), d’un long week-end (3 ou 4 jours, p = 0,023), et par le statut maculaire OFF (p = 0,008). Le délai moyen premiers signes/chirurgie était de 12,0 jours et était allongé par le statut maculaire OFF (p = 0,046) et par l’absence d’antécédent de décollement (p = 0,023). Aucune corrélation significative n’a été retrouvée entre les délais et la distance domicile/centre chirurgical.Le délai de prise en charge des DR est relativement court dans la région Midi-Pyrénées, même si nous avons pu constater un retard diagnostique relativement fréquent, notamment chez les DR Macula-OFF, peut-être en raison de la méconnaissance des symptômes par le patient et des difficultés d’accès aux consultations spécialisées. Aucune relation n’a été mise en évidence entre ce délai et la distance séparant le domicile du patient du lieu de prise en charge.Retinal detachment (RD) is a potentially blinding condition. Delay in management is a major prognostic factor. In our study, we analyzed the treatment delay for retinal detachments in the Midi-Pyrenees area, and factors which may influence it.Observational, cross-sectional, multicentric study, carried out over a 6-month period. Primary outcome: time between diagnosis and surgery. Secondary outcome: time between first symptoms and surgery. Non-parametric tests were used to analyze the influence of sociodemographic features, clinical features, distance between home and surgical center, and occurrence over a weekend.One hundred and fiftty-nine patients were included. The mean time between diagnosis and surgery was 4.4 ± 12.3 days (2.7 ± 4.3 for recent RD, less than 1 month), and was increased by the presence of a weekend (P < 0.001), or of a weekend with public holiday (P = 0.023), and by macular detachment (P = 0.008). The mean time between first symptoms and surgery was 12.0 days and was increased by the absence of RD history (P = 0.023), and by macular detachment (P = 0.046). No association was observed between these times to surgery and the distance between the patient's home address and the place of surgery.The time between diagnosis and surgery was relatively short in the Midi-Pyrénées area, but we often noted a delayed diagnosis, which may be due to the patient's lack of awareness of the symptoms and difficult access to specialty consultations. However, no relationship was found between this time-to-surgery and the distance between the patient's home and the surgical center.

We report the first case of endophthalmitis caused by Phoma glomerata. A 32-year-old man who underwent retinal detachment surgery consecutive to a penetrating globe injury presented with endophthalmitis 7 days after surgery. Anterior chamber tap and intravitreal injection of antibiotics (ceftazidime and vancomycin) were performed systematically. Fungus was observed at microscopic examination of the aqueous humor and treatment with intravitreal injection of amphotericin B was decided. The patient failed to improve with intravitreal amphotericin B but responded clinically to intravitreal voriconazole. The fungus was identified after culture as Phoma glomerata. The MIC for amphotericin B was 1microg/ml, for caspofungin was 2microg/ml, and for itraconazole was 8microg/ml or more. The MIC for voriconazole was up to 8microg/ml. The clinical response after intravitreal injection may be related to the high concentrations reached in the vitreous. Because of severity and ominous prognosis of intraocular fungal infections and posttraumatic Phoma ocular infections, aggressive management is required by intravitreal voriconazole administration.

Introduction: To evaluate the tolerance and efficacy of heavy silicone oil as internal tamponade for retinal detachment surgery.Patients and methods: Sixty-six eyes requiring heavy silicone oil for retinal detachment, with at least 1 month follow-up, were retrospectively studied. Preoperative status, surgical technique, tolerance, and anatomical and functional results were analyzed from the patient's file. Indications for heavy silicone injection were inferior retinotomy or inferior retraction in 65% of cases. PVR grade C was present in at least 63% of cases. Retinotomy was performed in 45% of cases. An exchange procedure was performed versus DKIine in 65% of cases. Mean follow-up was 7 +/- 4 months.Results: At the end of follow-up, 59% of eyes had a completely reattached retina, 32% without internal tamponade. Another surgery was necessary in 54% of cases. During follow-up, mean intraocular pressure was normal, and there was a significant intraocular inflammation in three cases (4.5%). In seven cases of the 44 ablations of heavy silicone oil, an adherence of residual bubbles was present. Redetachment occurred after ablation for anatomical success in 41% of cases. BCVA was better than 0.05 (20/400) in 54% of cases at the end of follow-up.Conclusion: Heavy silicone was well tolerated and seems not to be pro-inflammatory in our study. It is a good alternative to standard silicone for inferior retinotomy and inferior breaks without PVR. It is not a treatment of inferior retraction, and is not a long-term internal tamponade. During the ablation of heavy silicone oil, adherence of residual bubbles is possible, in which case a coaxial light or an endoillumination could be needed during ablation.

But de l'etude La tomographie en coherence optique (OCT) est une nouvelle technique d'imagerie non invasive, sans contact oculaire permettant une representation en coupe des structures de l'œil. Son principe comparable a l'echographie analyse la reflection d'une onde lumineuse de 850 nm. Le but de cette etude est d'evaluer l'apport de l'OCT pour le diagnostic et la surveillance des affections maculaires. Materiel et methodes La prise d'images est realisee sur l'OCT de Zeiss-Humphrey chez environ 300 patients atteints de trou maculaire idiopathique, de trou lamellaire, d'œdeme maculaire cystoide d'origine diverse, de neovaisseaux choroidiens, de membrane epiretinienne idiopathique, de maculopathie diabetique, de chorioretinite sereuse centrale durant un an d'utilisation de l'appareil. Resultats L'OCT apporte de nouvelles informations dans les affections du pole posterieur precitees. Les mesures d'epaisseur sont possibles. Conclusions L'OCT permet une analyse tomographique. Elle donne une image differente d'une coupe histologique, dont l'interpretation est parfois difficile. Elle est surtout performante dans l'etude des couches internes et son application reste a developper.

PURPOSE:Optical Coherence Tomography (OCT) is a novel noninvasive and noncontact imaging technique providing cross-sectional representations of the eye structures. OCT is analogous to Ultrasound B-scan, except that it analyzes the reflection of a 850 nm light wave. The aim of this study was to assess the potential of ocular coherence tomography for diagnosing and monitoring macular diseases.METHODS:Cross-sectional images were performed with the Zeiss-Humphrey OCT. Over one year period, we examined approximately 300 patients with idiopathic full thickness macular hole, lamellar hole, cystoid macular edema, choroidal new vessels, epiretinal membrane, diabetic maculopathy, and central serous chorioretinopathy.RESULTS:OCT can provide new information concerning the posterior pole diseases mentioned above. OCT can also be useful in thickness measurements.CONCLUSION:OCT allows tomographic analysis of macular diseases. The information obtained is different from that obtained by histologic study which is sometimes hard to interprete. OCT is mostly useful in studying internal layers of the retina. Further applications may be developed.

Purpose To analyse the surgical results of a second series of full thickness idiopathic macular hole operated with autologous serum as adjuvant therapy, and to compare them to the results of a first series without autologous serum and the results of literature. Methods In a series of thirty-six patients, autologous serum has been used as healing adjuvant therapy. The surgical procedure included a posterior and peripherical vitrectomy combined with posterior hyaloid separation, fluid-air exchange, autologous serum injection, and final flushing with 40% sulfur hexafluoride. The patients then maintained strict face-down position post-operatively for a minimum of ten days. Results Anatomic success was obtained in twenty-nine cases of thirty-six patients (80%), with an anatomic success rate of 100% for the stage 2 holes. Twenty-nine patients had a pre and postoperative measurable visual acuity. Among these twenty-nine patients, median postoperative visual acuity was 20/70, compared with 20/125 preoperatively. Final visual acuity was improved in twenty-seven patients (75%), was stable five times (14%), and declined four times (11%). Among the twenty-nine anatomic successes, twenty-four (85%) improved their visual acuity. Complications were rare, and observed in the same percentage as described in literature. No complication in relation to autologous serum was noticed. Conclusion Autologous serum is an inexpensive, easy to obtain, healing adjuvant therapy. It seems improving the surgical results like the other adjuvants described in the literature.