Assessing periocular inflammation is essential in several disorders, including Thyroid Eye Disease (TED). The Clinical Activity Score (CAS) is the most commonly used method to assess orbital inflammation, but is associated with significant inter-observer variability. The aim of this study was to assess the ability of Infrared Thermography (IRT) to detect orbital inflammation in TED and other orbital inflammation disorders (OOID). A retrospective study was conducted between March 2020 and November 2023. Patients were divided into four groups: active TED (CAS ≥ 3), non-active TED (CAS < 3), OOID, and healthy controls. Demographics, proptosis, and CAS were recorded. IRT was performed in 6 periocular areas, including the caruncle. Four IRT periocular patterns were characterized. Hundred and ten patients (63.64

Metastatic uveal melanomas are highly resistant to all existing treatments. To identify actionable vulnerabilities, we conducted a CRISPR-Cas9 knockout screen using a library composed of chromatin regulators. We revealed that the lysine methyltransferase, SETDB1, plays a critical role in metastatic uveal melanoma cell proliferation and survival. Functionally, SETDB1 deficiency induces a DNA damage response, senescence-like state and growth arrest. Knockdown of SETDB1 is associated with a decreased expression of genes related to replication and cell cycle. Moreover, deficiency in CDC6, an essential regulator of DNA replication, phenocopies SETDB1 inhibition. Using a pre-clinical model, we further demonstrated that anti-SETDB1 therapy impairs tumor growth in vivo. Therefore, we not only provide evidence that SETDB1 plays a critical role in metastatic uveal melanoma cell growth, but we also identify SETDB1 as a novel relevant therapeutic target for the treatment of metastatic uveal melanoma.

Purpose. - Treatment delays due to the COVID-19 pandemic in uveal melanoma (UM) patients have led to an increased rate of enucleations in Europe. The impact of multiple COVID-19 lockdowns on UM management has not been assessed in France. The goal of this study was to assess whether delayed diagnosis could have led to more advanced stages and thus a higher rate of enucleations.Methods. - Two datasets were analyzed: patients from two ocular oncology centers (dataset- 1), with recording of sizes, prognostic stages (TNM) and treatments, and a national database (dataset-2), obtained by ICD-10 codes and medical procedures for clip placement. After year- by-year comparison, the pre-COVID-19 (2018-2019) and post-COVID-19 (2021-2022) periods were compared for each dataset. Five hundred and thirty-seven patients were diagnosed with UM (dataset-1), including 213 patients in the pre-COVID-19 period and 212 patients in the post-COVID-19 period. Similarly, 2187 patients were diagnosed with UM (dataset-2), of whom 914 patients and 864 patients were diagnosed in the pre-COVID-19 and post-COVID-19 periods, respectively. Results. - A higher number of patients had locally advanced tumors during the post-COVID- 19 period compared to the pre-COVID-19 period (cT1 = 66, cT2 = 64, cT3 = 66 and cT4 = 21 vs. cT1 = 59, cT2 = 82, cT3 = 65 and cT4 = 7, P = 0.03), but without difference in ciliary body involve- ment, extraocular extension or AJCC stage (dataset-1). Treatments were similar between the pre-COVID-19 and post-COVID-19 periods in dataset-1 (P = 0.36) and dataset-2 (P = 0.47), with a higher ratio of proton beam therapy to primary enucleation in 2020 than in the pre-COVID-19 and post-COVID-19 periods (21.4 vs. 8.6 and 6.3, P = 0.02). Conclusion. - The COVID-19 pandemic did not impact the ophthalmological management of UM patients in France, but more locally advanced stages were observed upon initial presentation during the post-COVID-19 period. (c) 2024 The Author(s). Published by Elsevier Masson SAS. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

PURPOSE:The aim of this study was to report our experience and to provide a comprehensive understanding of the onset and course of orbital apex syndrome secondary to herpes zoster ophthalmicus (HZO-OAS). METHODS:A retrospective study was conducted in Nice University Hospital and Antibes Hospital (France) between January 2020 and December 2023. All patients diagnosed with HZO-OAS with at least a 1-month follow-up were included. RESULTS:Eight patients with a mean age of 81 (73-90) years were included. Half of the patients had underlying immunosuppression. The mean time between the onset of the vesicular rash and the development of HZO-OAS was 10 (2-19) days. HZO-OAS occurred while all patients were already treated with oral valacyclovir. The mean initial best-corrected visual acuity (BCVA) was 20/1093. All patients had concomitant ocular involvement, i.e. keratitis, anterior uveitis or both. Seven (87.5%) patients had optic neuritis. All patients were treated with intravenous acyclovir at neuro-meningeal doses. Oral steroids were prescribed in 62.5% of patients with gradual tapering. The mean BCVA was 20/87 at 3 months. Almost all patients experienced a complete resolution of ophthalmoplegia and ptosis at 3 months. Residual mydriasis was observed in 37.5% of patients. We proposed a schematic diagram describing the course of HZO-OAS. CONCLUSION:HZO-OAS is a rare but devastating complication occurring mainly in older and immunosuppressed patients despite treatment with oral antivirals. Early identification and treatment with intravenous acyclovir combined with steroids appear to be essential.

ObjectiveTo evaluate and compare characteristics, diagnosis, treatment, visual prognosis, and course between ocular sarcoidosis with or without uveitis in a population in Southern France.MethodsWe retrospectively analyzed data from patients with ocular sarcoidosis in a tertiary eye care center in Nice from January 2003 to December 2021. The inclusion criterion was biopsy-proven ocular sarcoidosis according to IWOS criteria as the first clinical manifestation of sarcoidosis.ResultsA total of 25 patients were included. Twenty patients had uveitis (70% panuveitis, 20% intermediate uveitis, and 10% anterior uveitis) and five patients had non-uveitic ocular sarcoidosis (one patient with dacryoadenitis, one patient with orbital granuloma, two patients with palpebral granuloma, and one patient with episcleritis). Only the cases with uveitis had bilateral involvement (85% of cases). There was no significant difference in ethnicity, biopsy diagnosis, systemic manifestations, or treatment between the two groups. Final visual outcomes remained good for both groups, with 96% of patients with BCVA>20/50, with no significant difference. Patients with non-uveitic sarcoidosis experienced less recurrence on treatment (P=0.042) and more remission (P=0.038) than patients with uveitis. Eighty percent of patients with uveitis had at least three suggestive clinical intraocular signs meeting IWOS criteria.ConclusionIn this population in Southern France, uveitis was the most common presentation of ocular sarcoidosis. The type of ocular sarcoidosis does not appear to be correlated with the type of systemic manifestations, use of systemic therapy, or visual prognosis, but patients with non-uveitic ocular sarcoidosis appear to have a better course with fewer recurrences on treatment and more remission than patients with uveitic ocular sarcoidosis.

Background. - Ptosis surgery is common in oculoplastics, and its most threatening complication is corneal ulceration. Several factors have been associated with postoperative corneal disorders, such as the strength of the orbicularis muscle, the type of surgery performed, and the Bell's phenomenon reflex (BPR). The goal of this study was to investigate the prevalence physiological BPR, absence of BPR, and presence of inverse BP in patients undergoing surgery for aponeurotic ptosis. The changes in the BPR during the postoperative course as well as the occurrence of corneal complications were also studied. Materials and methods. - A retrospective study was conducted at the University Hospital Nice from January 2018 to December 2023. Patients operated on for aponeurotic ptosis were included. Patients with myogenic or neurogenic ptosis or with missing data were excluded. Data were recorded preoperatively and one month postoperatively and included: eyelid height, orbicularis muscle strength, prevalence of BPR, lack of BPR, inverse BPR, and postoperative corneal ulcer. Results. - Ninety-eight eyelids of 57 patients were included over the study period. Preoperatively, the prevalence of physiological BPR, no BPR, and inverse BPR were 71.4%, 18.4%, and 10.2%, respectively. At one month postoperatively, 30.6% of patients experienced a change BPR (p p = 0.004). The postoperative prevalence of BPR, no BPR, and inverse BPR were 77.5%, 17.4%, and 5.1%, respectively. The rate of postoperative corneal ulcers was 1.02%. Conclusion. - Among patients operated on for aponeurotic ptosis, the prevalence of physiological BPR was 71.4% preoperatively. Approximately one-third of patients experienced a change in BPR one month postoperatively with a postoperative physiological BPR prevalence of 77.5%. The rate of corneal complications was low. (c) 2024 The Author(s). Published by Elsevier Masson SAS. This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/).

AIMS:To assess the efficacy and safety of a standardised hyperbaric oxygen therapy protocol (HBOT) monitored by fluorescein angiography (FA) in patients with retinal artery occlusion (RAO). METHODS:It is a prospective, non-comparative, monocentric study conducted between July 2016 and March 2022. All consecutive patients diagnosed with RAO within 7 days underwent visual acuity measurement, FA, macular optical coherence tomography (OCT) and OCT-angiography. They received two daily HBOT sessions (2.5 atmosphere absolute, 90 min) until revascularisation assessed by FA. Complete ophthalmic follow-up was scheduled at day 14, day 21 and at 1 month. The main outcome measure was a best-corrected visual acuity (BCVA) improvement defined as a decrease ≥0.3 logMAR at 1 month. RESULTS:Thirty-one patients were included and received a mean number of 33.9 (13-56) HBOT sessions. Retinal revascularisation was observed in 48.4% and 87.1% of patients at days 14 and 21, respectively. The mean BCVA on referral and at 1 month was 1.51 logMAR and 1.10 logMAR, respectively. Fifteen (48.4%) patients achieved the main outcome measure. Six (19.4%) patients experienced minor barotrauma that did not require HBOT discontinuation. The univariate analysis showed that antiplatelet-treated patients (p=0.044) and patients with a poor initial BCVA (p=0.008) were more likely to achieve a BCVA improvement. OCT-angiography was not sensitive enough to diagnose RAO or assess revascularisation. CONCLUSION:In RAO patients monitored by FA until spontaneous revascularisation of the central retinal artery, HBOT was effective and safe.

Background: Although visual field (VF) defects are common in compressive pituitary adenoma (CPA), their pathophysiology has not been fully elucidated. The mechanical theory (i.e., direct compression of the optic chiasm by the CPA) and the vascular theory (i.e., compression of the vessels supplying the visual path by the CPA) or their association could explain the visual impairment. The aim of this study was to determine whether the vascular density (VD) improved after surgical decompression of the optic chiasm in CPA patients and whether OCT-A could help to identify predictive factors for postoperative visual recovery. Methods: A prospective controlled study was conducted in patients who underwent transsphenoidal pituitary adenoma surgery. Patients were divided into two groups: with CPA and without CPA (NCPA). All patients underwent a neuro-ophthalmological examination, VF testing, macular and optic disc structural OCT [retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thicknesses] and OCT-A before and then 1 and 6 months after surgery. Results: Twenty-four eyes and fourteen eyes were included, respectively, in the CPA and NCPA groups. None of the VD parameters assessed by OCT-A were significantly improved after surgery in the CPA group. In the CPA group, the mean macular superficial VD was significantly decreased at 6 months. The multivariate analysis failed to identify any preoperative parameters predictive of postoperative VF improvement. Conclusions: Our preliminary findings suggest that the visual impairment observed in CPA patients could not be explained by the vascular theory. None of the preoperative OCT-A parameters allowed a postoperative VF recovery assessment. Trial registration number NCT04074642, ID-RCB 2019-A01186-51 date of registration 30 July 2019.

Background/Objectives: The aim of the study was to compare dacryocystectomy (DCT) versus dacryocystorhinostomy (DCR) in patients with dacryocystitis in terms of tearing complaints. Methods: We conducted a retrospective and comparative study on 19 patients. The main outcome measure was defined as an improvement by 1 point of the Munk score postoperatively. Results: A total of 19 patients were included with 10 in the DCR group and 9 in the DCT group. The primary endpoint was reached in 7 (70%) and in 6 (67%) patients in the DCR and DCT groups, respectively (p > 0.999). All DCR procedures were performed under general anesthesia (GA), while almost all DCT procedures were performed under local anesthesia (LA) (p < 0.001). There was a higher need for hospitalization in the DCR group (p < 0.001). Conclusions: Our preliminary results indicate that DCR is not always the solution in the case of dacryocystitis. DCT is a viable surgical procedure, especially in elderly patients without any tearing complaint and with underlying dry eye disease.

Dermal fillers are employed to bring balance and facial harmony, improving the proportions and asymmetries of the structures, besides acting to reverse the signs of facial aging. The periorbital region is one of the first to show the signs of aging with periocular wrinkles, deepening of the nasojugal and palpebromalar folds, prolapse of the fat bags, excess palpebral skin, ptosis of the eyelashes, disappearance of the upper eyelid crease due to excess skin and hollowing of the upper eyelid. The present chapter aims to describe the lines and furrows of the peripalpebral region and to present MD CODES™ algorithm for filling this region. This algorithm maps anatomical points of the face (anatomical codes) that, when treated with fillers, promote instantaneous lifting and rejuvenation. In addition to defining the points for treatment, this method identified the order of the points to be treated, i.e., which points should be prioritized to cause greater aesthetic impact. The MD CODES aim to standardize facial rejuvenation and is of particular interest for young as well as more experienced physicians. This chapter presents in detail the regions, the aesthetic effects of the application, the technique, the volume, and the target structure undertaken in the remodeling of the tear trough, periorbital, temporal, brow, and frontal regions.

Background. - Removal of orbital foreign bodies is a surgical challenge. The purpose of this study is to report our experience in the removal of orbital foreign bodies and to evaluate the usefulness of various technological aids in their removal. Materials and methods. - We conducted a single -center retrospective study at Nice University Hospital (France) from January 2017 to December 2023. All patients undergoing surgery for an orbital foreign body during the study period were included. Data recorded included the nature of the orbital foreign body, its size, location, surgical route, outcome (success, partial success, failure), and technological aids used (intraoperative navigation, intraoperative imaging scope, orbital magnet). Concurrently, we designed a dedicated orbital magnet, which was tested in the anatomy laboratory and in two of our patients. Results. - Six patients, all young men, were included during the study period. Removal was successful, partially successful, or unsuccessful in one-third of cases, respectively. Failure was associated with orbital foreign bodies located in the intraconal or posterior orbital space. Preoperatively, the use of a "low -artifact" scanner allowed us to better determine the exact size and shape of the orbital foreign body. Intraoperative navigation was not accurate enough, due to the mobility of the orbital bodies within the orbital fat. In our experience, intraoperative scope imaging was more accurate. The use of a dedicated orbital magnet was successfully tested in the anatomy laboratory and allowed the removal of a small orbital foreign body in one of our patients. Intraoperative surgical videos are provided. Conclusion. - Vegetal orbital foreign bodies must be systematically removed. Removal of nonvegetal orbital foreign bodies should be considered on a case -by -case basis based on their size, best assessed using a "low artifact" scanner, their location, and their intrinsic ferromagnetism. Intraoperative navigation does not appear useful, while intraoperative scope imaging does. A dedicated orbital magnet might be helpful in removing ferromagnetic orbital foreign bodies. However, an orbital magnet may be ineffective in removing intraorbital bullets, since they are made primarily of an alloy of copper and lead. (c) 2024 The Author(s). Published by Elsevier Masson SAS. All rights reserved.

To assess whether oculoplastic surgeries can be performed without any topical and systemic antibiotics, in a “100

Introduction La chirurgie du ptosis est une chirurgie fréquemment réalisée en oculoplastie dont la complication la plus redoutée est l’ulcère cornéen. Plusieurs facteurs favorisent la survenue de complications postopératoires comme la force du muscle orbiculaire, le type de chirurgie réalisée et le réflexe de Charles Bell (RCB). L’objectif était d’évaluer la prévalence du RCB physiologique, de l’absence de RCB et d’un RCB inverse chez des patients opérés de ptosis aponévrotique. L’évolution du RCB en postopératoire ainsi que la survenue de complications cornéennes étaient aussi étudiées. Matériel et méthode Une étude rétrospective a été menée au CHU de Nice de janvier 2018 à décembre 2023. Les patients présentant un ptosis aponévrotique étaient inclus. Les patients présentant un ptosis myogénique et neurogénique ou des données manquantes étaient exclus. Les données étaient recueillies en préopératoire et à 1 mois postopératoire : fente palpébrale, force du muscle orbiculaire, prévalence du RCB, absence de RCB, RCB inverse, ulcère cornéen postopératoire. Résultats Quatre-vingt dix-huit paupières de 57 patients ont été inclus pendant la période d’étude. La prévalence du RCB physiologique, de l’absence de RCB et d’un RCB inverse en préopératoire était de 71,4 %, 18,4 % et 10,2 %, respectivement. À 1 mois postopératoire, 30,6 % des patients ont présenté une modification du RCB (p=0,004). La prévalence postopératoire du RCB physiologique, de l’absence de RCB et d’un RCB inverse était de 77,5 %, 17,4 % et 5,1 %, respectivement. Le taux de complication cornéenne était de 1,02 %. Conclusion Parmi les patients opérés de ptosis aponévrotiques, la prévalence du RCB physiologique était de 71,4 % en préopératoire. Environ un tiers des patients présentaient des modifications du RCB à un mois postopératoire avec une prévalence postopératoire du RCB physiologique de 77,5 %. Le taux de complications cornéennes est faible.