Handicap evaluation in adults with acquired or progressive congenital visual loss allows for identification of the individual's specific needs and targeted therapy (medical, technical, rehabilitative and psychological). Currently, the subjective dimension of the handicap remains poorly explored in the field of visual loss. Our questionnaire aims to understand the whole of these subjective impacts. It differs from existing quality of life scales in ophthalmology in its approach centered on the process of adaptation, individual resources (technical, cognitive, psychic and environmental), and investigation of the perception of the handicap. The goal of the present study is to validate this questionnaire, which could be used in any adult with a visual handicap, regardless of the extent of the visual loss, its etiology, or the type of treatment or compensatory mechanisms.The Assessment Questionnaire on the Perception of and Adaptation to Visual Handicap in Adults (QUEPAHVA) is composed of 28 items relating to perception of the visual impairment, its impact, and adaptive resources. They are divided into 3 sub-categories: Perception of daily life and relationships (10 items), Perception of visual status and compensatory mechanisms (8 items), and Psychological impact of the visual handicap (10 items). The responses are graded on a Likert scale. Factor analysis and verification of psychometric qualities were performed based on the responses of 446 subjects. The discriminatory validity of the NEI-VFQ 25 was proven with 99 subjects. Reliability over time (mean interval between T1 and T2 = 49.43 days) was measured in 31 subjects. Sensitivity to change between pre- and post-management (mean interval between T1 and T2 = 410 days) was tested in 123 subjects.Internal consistency was very good for the global scale (α = .90) as well as for the 3 sub-dimensions (α = .86; α = .79; α = .80). The discriminatory validity was satisfactory (r = .70). This result had to be interpreted as a function of the qualitative specificity of the questionnaire. The questionnaire enjoyed good reproducibility over time with regard to its total score and relatively satisfactory reproducibility with regard to its sub-dimensions. Sensitivity to change was very high and accounted for adaptations to the disability over time.The QUEPAHVA displays good psychometric qualities. It constitutes a new means of evaluation. Its potential applications are many. It permits evaluation of the needs of the individual and adaptation of the protocol of care. Its use in institutions may support a step forward in the science of evaluation and continued improvement in quality of care.

La chirurgie combinée cataracte-vitrectomie se complique fréquemment par l’opacification de la capsule postérieure et par l’apparition de synéchies postérieures de l’iris. Ces complications peuvent être évitées par la mise en place d’un implant « bag in the lens » (BIL). L’objectif de cette étude est de comparer le gain d’acuité visuelle (AV) après chirurgie combinée cataracte-vitrectomie entre un groupe implanté suivant la technique BIL et un groupe avec une implantation dans le sac (IS).Nous avons inclus dans l’étude toutes les phaco-vitrectomies pour membrane épi-rétinienne et traction vitréo-maculaire réalisées entre mai 2013 et juillet 2016 au Centre Hospitalier et Universitaire de Caen. Nous avons comparé le gain d’AV à six mois de l’intervention entre le groupe BIL et le groupe IS.Au total, 33 patients ont été inclus dans l’étude dont 28 yeux dans le groupe BIL et 8 yeux dans le groupe IS. Le gain moyen d’AV dans le groupe BIL était de −0,52 LogMAR (p < 0,0001) et de −0,56 LogMAR (p = 0,0047) pour le groupe IS. La différence entre les deux groupes n’était pas significative (p = 0,74).L’utilisation de la technique BIL lors des phaco-vitrectomies permet une récupération visuelle aussi bonne que lors d’une implantation dans le sac capsulaire. De plus cet implant a pour avantage de diminuer significativement l’apparition de synéchies postérieures de l’iris et d’empêcher la prolifération capsulaire postérieure et antérieure.Combined vitrectomy-lensectomy surgery is a safe and effective procedure. Nevertheless, it is frequently complicated by posterior capsule opacification and the formation of posterior synechiae. These complications can be avoided by placing a “bag in the lens” (BIL) implant. The objective of this study is to compare the visual acuity gain (VA) after combined vitrectomy-lensectomy surgery between a group implanted with the BIL technique and a group with implantation in the bag (LIB).We included in the study all vitrectomy-lensectomy procedures for epiretinal membrane and vitreomacular traction performed between May 2013 and July 2016 at the Hospital and University Center of Caen. We compared the VA gain between the BIL group and the LIB group six months after surgery.A total of 33 patients were included in the study, consisting of 28 eyes in the BIL group and 8 eyes in the LIB group. The mean VA gain in the BIL group was −0.52 LogMAR (P < 0.0001) and −0.56 LogMAR (P = 0.0047) for the LIB group. The difference between the two groups was not significant (P = 0.74).The use of the BIL technique during vitrectomy-lensectomy allows visual recovery as good as implantation within the capsular bag. In addition, this implant has the advantage of significantly reducing the occurrence of posterior synechiae and preventing anterior and posterior capsular proliferation.

To study macular involvement on SD-OCT in sarcoidosis uveitis at active and sequelae phases. Twenty-nine eyes of 16 patients with sarcoidosis uveitis were retrospectively reviewed. All patients underwent complete ophthalmic examination completed with fluorescein angiography and SD-OCT to assess macular involvement at active and sequelae phases of the disease. The mean age was 44,6 ± 12,4 years. There were 8 men and 8 women. 19 eyes were assessed by SD-OCT at the active phase and 10 eyes at the sequelae phase. At the active phase, SD-OCT showed macular involvement in 9 (47,3%) eyes which consisted in cystoid macular edema in 5 eyes with serous retinal detachement in 3 eyes, epiretinal memebrane in 2 eyes and macular thinning in 2 eyes. At the sequelae phase, macular involvement was observed in 5 (50%) eyes which consisted in cystoid macular edema in 2 eyes, epiretinal membrane in 2 eyes and macular thinning in one eye. Macular involvement in sarcoidosis uveitis is common. Cystoid macular edema was the most frequent macular complication. Epiretinal membrane can be seen either in the initial presentation or during follow-up as a sequelae of the disease. Macular atrophy may be a complication of sarcoidosis uveitis at the active and squelae phases. Macular thinning and, more importantly, photoreceptor degeneration are serious sequelae of this process. OCT can help identify abnormality of the ellipsoid zone.

PurposeTo study the contribution of onset‐offset visual evoked potentials (VEP) in the diagnosis of ocular albinism in infantile nystagmus.MethodsCase report.ResultsObservations: Two girls aged respectively three‐year old and six‐year old presented with infantile nystagmus. Ophthalmic examination showed visual acuity of 2/10 bilaterally, a brown iris, with positive transillumination and depigmented fundus without any other depigmentation of skin or hair. Flash VEP showed probable crossed asymmetry of P2 amplitude. P100 wave was unrecordable in 60’ Pattern VEP. 60’ onset‐offset VEP were performed and showed evident crossed asymmetry in C1 and C2 waves which confirmed the diagnosis of ocular albinism. SD‐OCT was also performed and showed foveal hypoplasia.ConclusionsOcular albinism is more difficult to diagnose than the oculo‐cutaneous albinism since it is limited to ophthalmic manifestations. Onset‐offset VEP are very useful in nystagmus patients because they are less sensitive to ocular oscillations and showed more evident crossed asymmetry than flash or pattern VEP.

PurposeTo study the combination of global electroretinogram (ERG) and SD‐OCT in the etiology of infantile nystagmus.MethodsSixteen children with infantile nystagmus, and no evident etiology in the normal ophthalmic examination underwent ERG with ISCEV guidelines and SD‐OCT.ResultsMedian age was 8.7 ± 2.9 years (3.4–14.6 years). ERG and SD‐OCT were both normal in 6 children. In 9 children, ERG showed cone dysfunction and OCT allowed differentiation between achromatopsia in 4 children and cone dystrophy in 5 children. Two children had rod and cone dysfunction in ERG and OCT was normal. Dysfunction in inner‐layer retina was found in one child who had X‐linked juvenile retinoschisis diagnosed with OCT.ConclusionsERG is useful in the etiologic diagnosis and prognosis of infantile nystagmus. Its combination with SD‐OCT allows better characterization of the etiology of nystagmus especially in diseases involving the macula which may guide molecular study, help performing genetic counseling, and facilitate future gene therapy.

PurposeTo investigate the correlation between the presence of a bulge in the photoreceptor inner segment/outer segment (IS/OS) line and the best corrected visual acuity (BCVA) in eyes with resolved macular edema associated with branch retinal vein occlusion (BRVO).MethodsA total of 17 eyes (17 patients) with macular edema associated with BRVO were evaluated. The medical records of patients who had a complete resolution of macular edema with intact IS/OS line in the central fovea on spectral‐domain optical coherence tomography (SD‐OCT) images were retrospectively reviewed. These eyes were classified into those with foveal bulge and those without foveal bulge and the characteristics of the 2 groups were compared.ResultsTwelve eyes (70.5%) had complete resolution of macular edema after a mean follow up of 24.1 months. A foveal bulge was present in 9 of 17 eyes with resolved macular edema. The BCVA was significantly better in eyes with a foveal bulge than in eyes without foveal bulge (p < 0.001). All eyes with foveal bulge had a decimal BCVA less than 0.5 against only 28.6% in eyes without foveal bulge (p = 0.011).ConclusionsFoveal bulge seems to be frequent in resolved macular edema associated with BRVO. Visual acuity was significantly better in the subgroup with foveal bulge making it a potential good marker of the functional properties of the fovea.

PurposeTo identify quantitative and qualitative spectral‐domain optical coherence tomography (SD‐OCT) prognostic factors for visual outcome in patients with macular edema secondary to retinal vein occlusion.MethodsFourty one patients (41eyes) with retinal vein occlusion were retrospectively analyzed with SD‐OCT before and after resolution of macular edema. We evaluated the influence of these patterns on visual acuity: central macular thickness, total macular volume (TMV), continuity of the junction between photoreceptor inner and outer segments (IS/OS), of the external limiting membrane (ELM) and of the internal limiting membrane (ILM), and the number of hyperreflective foci.ResultsThe logMAR VA was significantly better in eyes with continuous IS/OS line, ELM and ILM (p < 0.001) and in eyes with a lower number of hyperreflective foci (p = 0.032). Visual acuity was also statistically better in patients with a thinner central retinal thickness (p = 0.046) and a less total macular volume (p = 0.023) in patients with BRVO.ConclusionsSD‐OCT seems to be helpful in predicting visual outcomes in macular edema associated with retinal vein occlusion and shows that outer layers integrity was closely associated with visual prognosis.

Mesurer en spectral domain OCT (OCT-SD), l'épaisseur choroïdienne fovéolaire chez les patients myopes forts présentant un glaucome primitif à angle ouvert et de la comparer à des yeux myopes forts sans glaucome. Nous avons mené une étude transversale qui a concerné 48 yeux myopes forts glaucomateux appariés selon l'âge, l'épaisseur cornéenne centrale et l'équivalent sphérique avec 48 yeux myopes forts non glaucomateux. Les examens en OCT ont été réalisés par l'appareil OCT spectral domain (OCT Topcon 2000). L'épaisseur choroïdienne fovéolaire a été mesurée manuellement entre la membrane de Bruch et la portion interne de la sclère. Dans le groupe sans glaucome, apparié avec le groupe avec glaucome selon l'âge (p = 0,57), l'épaisseur cornéenne centrale (p = 0,33) et l'ES (p = 0,10), l'épaisseur choroïdienne fovéolaire était de 96,32 μm ± 39,56 μm. Dans le groupe avec glaucome, l'épaisseur choroïdienne fovéolaire était de 50,44 μm ± 16,36 μm. L'épaisseur choroïdienne sous-fovéolaire était significativement plus basse dans les yeux myopes forts glaucomateux par rapport aux yeux myopes forts sans glaucome (p = 10−4). L'épaisseur choroïdienne fovéolaire est diminuée chez les myopes forts glaucomateux. L'amincissement choroïdien peut être un paramètre utile pour le diagnostic et le suivi des myopes forts glaucomateux. To measure macular choroidal thickness (CT) using spectral domain optical coherence tomography (OCT) in high myopic eyes with primary angle-open glaucoma (POAG), and to investigate whether the choroid is thinner in these eyes compared to high myopic eyes without glaucoma. We conducted a cross-sectional study of forty-eight eyes with high myopic glaucoma matched with 48 highly myopic eyes without glaucoma by age, central corneal thickness and axial length (AL). OCT scans were performed with the spectral domain OCT (Topcon 2000). The subfoveal CT was measured between the Bruch membrane and the internal aspect of the sclera. In the subgroup without glaucoma, matched with the subgroup with glaucoma (P = 0.57), by age, central corneal thickness (P = 0.33) and AL (P = 0.10), the mean subfoveal CT was 96.32 μm ± 39.56 μm. In the subgroup with glaucoma, the mean subfoveal CT was 50.44 μm ± 16.36 μm. The comparison between the two subgroups found a statistically significant difference in subfoveal CT (P < 10−4). Foveal choroidal thickness is reduced in highly myopic eyes with glaucoma. The choroidal thinning can be a useful parameter for the diagnosis and the follow-up of highly myopic patients with glaucoma.

PURPOSE:To measure macular choroidal thickness (CT) using spectral domain optical coherence tomography (OCT) in high myopic eyes with primary angle-open glaucoma (POAG), and to investigate whether the choroid is thinner in these eyes compared to high myopic eyes without glaucoma. PATIENTS AND METHODS:We conducted a cross-sectional study of forty-eight eyes with high myopic glaucoma matched with 48 highly myopic eyes without glaucoma by age, central corneal thickness and axial length (AL). OCT scans were performed with the spectral domain OCT (Topcon 2000). The subfoveal CT was measured between the Bruch membrane and the internal aspect of the sclera. RESULTS:In the subgroup without glaucoma, matched with the subgroup with glaucoma (P=0.57), by age, central corneal thickness (P=0.33) and AL (P=0.10), the mean subfoveal CT was 96.32 μm ± 39.56 μm. In the subgroup with glaucoma, the mean subfoveal CT was 50.44 μm ± 16.36 μm. The comparison between the two subgroups found a statistically significant difference in subfoveal CT (P<10(-4)). CONCLUSIONS:Foveal choroidal thickness is reduced in highly myopic eyes with glaucoma. The choroidal thinning can be a useful parameter for the diagnosis and the follow-up of highly myopic patients with glaucoma.

Purpose To investigate the correlation of retinal thickness measured with SD OCT and visual acuity in eyes with diabetic macular edema ( DME ) before and after intravitreal injection of anti‐ VEGF Methods Seventy‐four patients (96 eyes) with DME who underwent three monthly intravitreal injection of bevacizumab ( IVB ) as their first treatment. Type of DM , duration, treatment, laboratory examinations, history of cardiovascular disease, hypertension, hyperlipidemia, diabetic nephropathy, were documented. Logarithm of the minimum angle of resolution (log MAR ) best corrected visual acuity ( BCVA ) was evaluated using the international vision test chart. Foveal thickness was measured by SD OCT . Results The correlation coefficients for visual acuity ( VA ) versus OCT center point thickness were 0.57 at baseline and 0.47, 0.38, and 0.40 at 1, 3, and 6 months post‐laser photocoagulation. A subset of eyes showed paradoxical improvements in VA with increased center point thickening (5–13% at the three time points) or paradoxical worsening of VA with a decrease in center point thickening (12–24% at the three time points). Conclusions There is modest correlation between OCT ‐measured center point thickness and VA , and modest correlation of changes in retinal thickening and visual acuity following focal laser treatment for DME . In addition, paradoxical changes in VA and retinal thickening may be observed. Indeed, retinal thickness only accounts for up to 27% of variability in concurrently measured VA suggesting that other factors are important determinants of VA in the presence of diabetic macular edema.

To measure macular choroidal thickness (CT) using spectral domain optical coherence tomography (OCT) in high myopic eyes with primary angle-open glaucoma (POAG), and to investigate whether the choroid is thinner in these eyes compared to high myopic eyes without glaucoma. We conducted a cross-sectional study of 68 eyes with high myopic glaucoma matched with 68 highly myopic eyes without glaucoma by age, central corneal thickness and axial length (AL). OCT scans were performed with the spectral domain OCT (Topcon 2000). The subfoveal CT was measured between the Bruch membrane and the internal aspect of the sclera. In the subgroup without glaucoma, matched with the subgroup with glaucoma by age ( P  =   0.48), central corneal thickness ( P  =   0.28) and AL ( P  =   0.14), the mean subfoveal CT was 98.56  μ m ± 31.37  μ m. In the subgroup with glaucoma, the mean subfoveal CT was 51.32  μ m ± 18.44  μ m. The comparison between the two subgroups found a statistically significant difference in subfoveal CT ( P  <   0.0001). Foveal choroidal thickness is reduced in highly myopic eyes with glaucoma. The choroidal thinning can be a useful parameter for the diagnosis and the follow-up of highly myopic patients with glaucoma.

Purpose. - To investigate the microbiological profile of acute postoperative endophthalmitis in a referral center in Tunisia and to assess the antibiotic sensitivity of the organisms.Patients and methods. - This is a retrospective study over a period of eleven years, conducted on patients hospitalized with acute infectious postoperative endophthalmitis. Cultures were performed on aqueous (93%) and vitreous specimens (68%) obtained at presentation. Each sample underwent direct examination, culture and antibiotic susceptibilities.Results. - The number of acute postoperative endophthalmitis cases identified during the study period was 308. Organisms were found in 43% of samples (endophthalmitis was bacterial in 39.5%, fungal in 0.9% and polymicrobial in 2.6%). Cultures grew primarily Staphylococcus epidermidis in 31.4% of cases, Streptococcus pneumoniae in 22.7% of cases and Staphylococcus aureus in 12.7% of cases. Gram-positive cocci are more sensitive to vancomycin and Gram-negative bacilli are more susceptible to ofloxacin and ciprofloxacin.Conclusion. - In our study, microbiological samples were positive in 43% and coagulase-negative Gram-positive cocci are the most common organisms. However, antibiotic resistance has been increasing over the years. (C) 2015 Elsevier Masson SAS. All rights reserved.

Purpose. - To measure macular choroidal thickness (CT) using spectral-domain optical coherence tomography (SD-OCT) in highly myopic eyes with dome-shaped macula (DSM), and to investigate whether the choroid is thicker in these eyes compared to highly myopic eyes without MB.Patients and methods. - A cross-sectional study of 200 eyes was performed between January 2010 and June 2012. Twenty-four highly myopic eyes (12%) had a dome-shaped macula. All patients underwent a complete ophthalmological examination, SD-OCT (TOPCON 2000), and B-scan ultrasonography. OCT scans were analyzed in 7 sections, and subfoveal CT was measured manually between the Bruch's membrane and the internal aspect of the sclera. The 20 eyes with isolated dome-shaped macular were paired by age and axial length (AL) with 20 eyes without macular involvement.Results. - In the subgroup with isolated MB, the mean subfoveal CT was 101.86 mu m (+/- 21.35 mu m). A statistically significant negative correlation was found between CT and AL (r = -0.623, P = 0.0001). The regression equation demonstrated a decrease of 8.3 mu m per mm of AL. In the subgroup without MB, matched with the subgroup with MB by age (P = 0.591), and AL (P = 0.815), the mean subfoveal CT was 89.54 mu m (+/- 20.12 mu m). The comparison between the two subgroups found a statistically significant difference in subfoveal CT (P < 10-4).Conclusions. - In our study, choroidal thickness is increased in highly myopic eyes with dome-shaped macula compared to highly myopic eyes without dome-shaped macula. These findings suggest that abnormalities of the choroid may play a role in the pathogenesis of dome-shaped macula. (C) 2014 Elsevier Masson SAS. All rights reserved.