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PURPOSE: To assess the clinical efficacy and safety of T2769, a new preservative-free eye drop combining hyaluronic acid (HA), trehalose and N-acetyl-aspartyl-glutamic acid (NAAGA), in dry eye patients. PATIENTS AND METHODS: This was a multicenter, non-comparative, open-label study. After a run-in period with NaCl 0.9% solution, 62 patients with moderate-to-severe dry eye disease (DED) were included and treated with T2769, 3 to 6 times/day for 42 days. The primary efficacy endpoint was the change in global ocular symptomatology assessed on a visual analog scale between Day 1 (D1) and D42. Other efficacy endpoints included ocular surface disease index (OSDI), soothing sensation, individual dry eye symptoms, conjunctival hyperemia, global ocular staining, tear break-up time, Schirmer test, and global efficacy assessed by the investigator. Safety was assessed throughout the study. RESULTS: A marked reduction in ocular symptomatology was observed from D1 to D42 with a mean change of -55.9±23.1mm (P<0.001). This was accompanied by a mean change in OSDI score from baseline of -44.6±15.9 (P<0.001) and a substantial soothing sensation in 82.3% of patients. Clinically significant improvements were observed for all ocular symptoms (mainly burning/irritation, stinging/pain, feeling of ocular dryness, foreign body sensation, itching/pruritus). Conjunctival hyperemia significantly decreased in 96.8% of patients (56.5% displayed no conjunctival hyperemia at D42 versus 0% at baseline). All signs and symptoms improved by D14 and further improved at D42. Investigators assessed the ocular efficacy of T2769 as very satisfactory or satisfactory for 91.9% of patients at D42. T2769 was well tolerated, with no ocular adverse events and only a few ocular symptoms upon instillation. CONCLUSION: Management of moderate-to-severe DED patients with the new formulation T2769, combining NAAGA to HA and trehalose, led to rapid and significant improvements in dry eye signs and symptoms with good tolerability.

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Universal mask wear is an effective public health intervention to reduce SARS-Cov-2 transmission, especially in enclosed public spaces and healthcare environments. Concerns have been raised about possible transmission of the SARS-Cov-2 through ocular secretions, leading to enhanced protective measures during ophthalmic procedures. However, there is some evidence for air jets from the upper edge of the surgical mask to the ocular surface, especially when the mask is not well fit. Prolonged airflow towards the ocular surface during expiration may alter tear-film stability, leading to hyperosmolarity and ocular surface inflammation. This also raises the question of whether the ocular surface is contaminated with oral flora from airflow directed toward the eyes, thus increasing the risk of ocular infection. Herein we review the impact of patient face mask wear on the ocular surface, eyelids and risk of ocular infection, particularly during ocular surgery. There is some evidence for increased incidence of dry eye or eyelid disease during periods of mandatory face mask wear. While high daily exposure is consistent with a direct association, this should be mitigated by various cofounding factors which could also affect the ocular health during the COVID-19 pandemic. An increased risk of post-intravitreal injection endophthalmitis, possibly due to face mask wear by the patient, including culture-positive endophthalmitis, has been reported in one retrospective study. Several measures have been shown to prevent or limit the risk of developing dry eye disease or exacerbation, eyelid cyst, and ocular infection during intravitreal injections.

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BACKGROUND: Ocular rosacea is a chronic inflammatory disorder with periods of exacerbation and remission, often underdiagnosed in children. When diagnosed, its management is challenging because of a lack of effective long-term treatment options. OBJECTIVE: To report our experience in cases of pediatric ocular rosacea treated with moist heat therapy and topical azithromycin 1.5%. METHODS: The medical records of six children diagnosed with ocular rosacea based on a careful medical history and slit-lamp examination of the eyelids and ocular surface were reviewed. Previous treatments were discontinued, and children/parents were instructed to use the eyelid-warming device for 1 or 2 sessions of 10minutes each day, followed by eyelid massage and cleansing, in combination with azithromycin 1.5% eye drops. RESULTS: The diagnosis of ocular rosacea in these children was delayed for several months or years from the first identifiable clinical sign or symptom. All the children presented with corneal sequelae and decreased vision. Ocular manifestations included meibomian gland disease, recurrent chalazia, and phlyctenular keratoconjunctivitis. Cutaneous signs were not always associated with the condition. Ocular rosacea was usually resistant to initial treatments with antibiotics and topical corticosteroids. Treatment with the eyelid-warming device in combination with azithromycin 1.5% led to a rapid improvement in the clinical signs and was well tolerated by all patients. CONCLUSIONS: Childhood ocular rosacea is potentially sight threatening. Practitioners should consider this condition in order to minimise diagnostic delay and subsequent complications. Combined therapy of eyelid hygiene (including an eyelid warming device) and azithromycin 1.5% eye drops was effective in treating ocular rosacea in children.

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Congenital aniridia is a rare panocular disease defined by a national diagnostic and care protocol (PNDS) validated by the HAS. In most cases, it is due to an abnormality in the PAX6 gene, located at 11p13. Aniridia is a potentially blinding autosomal dominant disease with high penetrance. The prevalence varies from 1/40,000 births to 1/96,000 births. Approximately one third of cases are sporadic. Ocular involvement includes complete or partial absence of iris tissue, corneal opacification with neovascularization, glaucoma, cataract, foveal hypoplasia, optic disc hypoplasia and ptosis. These ocular disorders coexist to varying degrees and progress with age. Congenital aniridia manifests in the first months of life as nystagmus, visual impairment and photophobia. A syndromic form such as WAGR syndrome, WAGRO syndrome (due to the risk of renal Wilms tumor) or Gillespie syndrome (cerebellar ataxia) must be ruled out. Systemic associations may include diabetes, due to expression of the PAX6 gene in the pancreas, as well as other extraocular manifestations. Initial assessment is best carried out in a referral center specialized in rare ophthalmologic diseases, with annual follow-up. The management of progressive ocular involvement must be both proactive and responsive, with medical and surgical management. Visual impairment and photophobia result in disability, leading to difficulties in mobility, movement, communication, learning, fine motor skills, and autonomy, with consequences in personal, school, professional, socio-cultural and athletic life. Medico-socio-educational care involves a multidisciplinary team. Disability rehabilitation must be implemented to prevent and limit situations of handicap in activities of daily living, relying on the Commission for the Rights and Autonomy of People with Disabilities (CDAPH) within the Departmental House of People with Disabilities (MDPH). The general practitioner coordinates multidisciplinary medical and paramedical care.

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Tattooing of the glove is an old practice used 2000 years ago on the cornea to improve the appearance of unsightly corneal scars. Since 2007, tattoo artists have been performing scleral tattoos, also called "eyeball tattoos," despite the risks involved and the disapproval of health authorities and the medical community. We report the case of a 30-year-old man with bilateral black ink scleral tattoos who came to our ophthalmologic emergency service with episcleral nodules, which had appeared at the ink injection sites. The clinical course stabilized with topical anti-inflammatory treatment. Similar cases have been reported in the literature, in one of which the patient underwent surgical excision of a similar lesion. Histological analysis showed a lympho-histiocytic reaction without any signs of malignancy. To date, 20 cases of scleral tattoos have been reported in the international literature, often with severe complications. We see, on the one hand, complications related to perforating trauma, and on the other hand, acute and chronic complications inherent to the products used. Scleral tattooing is gaining popularity around the world despite significant risk exposure, including traumatic, inflammatory, immune, infectious and probably long-term neoplastic consequences. Ophthalmologists must be aware of this practice and its consequences in order to make the most appropriate therapeutic decisions.

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OBJECTIVE: To evaluate diagnostic and therapeutic practices and then establish a consensus on the management of ocular toxoplasmosis in France through a Delphi study. MATERIALS AND METHODS: Twenty-three French experts in ocular toxoplasmosis were invited to respond to a modified Delphi study conducted online, in the form of two questionnaires, in an attempt to establish a consensus on the diagnosis and management of this pathology. The threshold for identical responses to reach consensus was set at 70 %. RESULTS: The responses of 19 experts out of the 23 selected were obtained on the first questionnaire and 16 experts on the second. The main elements agreed upon by the experts were to treat patients with a decrease in visual acuity or an infectious focus within the posterior pole, to treat peripheral lesions only in the presence of significant inflammation, the prescription of first-line treatment with pyrimethamine-azithromycin, the use of corticosteroid therapy after a period of 24 to 48hours, the prophylaxis of frequent recurrences (more than 2 episodes per year) with trimethoprim-sulfamethoxazole as well as the implementation of prophylactic treatment of recurrences in immunocompromised patients. On the other hand, no consensus emerged with regard to the examinations to be carried out for the etiological diagnosis (anterior chamber paracentesis, fluorescein angiography, serology, etc.), second-line treatment (in the case of failure of first-line treatment), or treatment of peripheral foci. CONCLUSION: This study lays the foundations for possible randomized scientific studies to be conducted to clarify the management of ocular toxoplasmosis, on the one hand to confirm consensual clinical practices and on the other hand to guide practices for which no formal consensus has been demonstrated.

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BACKGROUND: Visual illusions (VI) in Parkinson's disease (PD) are generally considered part of the prodrome towards fully formed visual hallucinations (VH), and classified as minor hallucinations. However, this sequential relationship has not been clearly demonstrated and very little is known about the specific phenomenology of VI in regards to VH. We aimed to describe and compare psycho-sensory modalities associated with VI and VH in PD patients. METHODS: PD patients with VI (PD-I, n=26) and VH (PD-H, n=28) were included in this case-controlled study. We compared qualitative and quantitative psycho-sensory modalities of VI and VH using the PsychoSensory hAllucinations Scale (PSAS), and demographical and clinical features of each group. RESULTS: PD-I perceptions were more often colored blots (P=0.05) or objects (P=0.005) compared to PD-H. Conversely, PD-H perceptions were more often described as animals (P<0.001), occurring at night (P=0.03) compared to PD-I. The experienced phenomena were more frequent in PD-H (P=0.02), and lasted longer (P=0.02) than for PD-I, but no between-group difference was observed for other repercussion factors including negative aspect, conviction, impact, controllable nature of the perception. Passage hallucinations and sense of presence were observed in both groups with similar frequencies (respectively P=0.60 and P=0.70). Multivariate analysis adjusting for disease severity or duration confirmed these results. CONCLUSION: VI and VH in PD have different qualitative sensory modalities, with similar quantitative repercussion for patients, and similar association with modalities such as "sense of presence and passage hallucinations", in contrast to the generally accepted classification of VI as minor VH. REGISTRATION NUMBER: clinicaltrials.gov number NCT03454269.

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OBJECTIVES: To evaluate the functional and anatomic recovery of submacular hemorrhage (SMH), treated with vitrectomy, subretinal injection of rtPA and gas tamponade, to highlight the risk factors for their occurrence as well as the factors influencing prognosis. MATERIALS AND METHODS: This is a single-center retrospective study. Thirty-two eyes of 30 patients from the Clermont-Ferrand University Hospital were included, with a submacular hemorrhage (SMH) requiring surgical evacuation. The primary endpoint was final postoperative visual recovery. Visual acuities (AV) were converted to the logarithmic minimum angle of resolution scale (logMAR) for statistical analysis. RESULTS: The average time from onset of symptoms to surgery was 4.8±3.3 days. The initial VA was 2.1±0.3 logMAR, with an average improvement of 0.7±0.7 logMAR (P=0.0004) at the final visit. The mean thickness of the SMH decreased by 729±352µm (P<0.0001) at the final visit. CONCLUSION: Treatment of SMH with vitrectomy, subretinal injection of rtPA and gas tamponade results in a statistically significant improvement in final VA, as well as a significant decrease in SMH thickness on OCT.

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PURPOSE: To assess visual improvement in patients with pellucid marginal degeneration (PMD) after fitting with SPOT® scleral contact lenses (Scleral Protection & Ocular Treatment, Laboratoires d'Appareillage Oculaire, Amphion-Les-Bains, France). METHODS: We report a case series of 5 patients with PMD and unsatisfactory refractive correction managed at Clermont-Ferrand university hospital from January to December 2018 fitted with customized SPOT scleral lenses. We assessed the best-corrected visual acuity (BVCA) before and after fitting with SPOT, keratometric data and tolerability of the scleral lenses. RESULTS: Nine eyes of 5 patients aged 51.8±8.47 years were fitted. The BVCA was significantly improved from 0.51 logMAR (±0.39) to 0.04 logMAR (±0.07) (P<0.001). Sixty-six percent of the patients recovered optimal BVCA. No serious adverse event was reported. The presence of whitish deposits and an inordinate amount of manipulation required were the main disadvantages of the lenses. Nevertheless, all the patients considered them to be comfortable. CONCLUSION: Fitting PMD patients who have failed conventional optical devices with SPOT scleral lenses significantly improves BCVA, without serious adverse events, allowing surgery to be deferred even when it appears to be unavoidable.

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PURPOSE: To assess visual improvement in patients with pellucid marginal degeneration (PMD) after fitting with SPOT® scleral contact lenses (Scleral Protection & Ocular Treatment, Laboratoires d'Appareillage Oculaire, Amphion-Les-Bains, France). METHODS: We report a case series of 5 patients with PMD and unsatisfactory refractive correction managed at Clermont-Ferrand university hospital from January to December 2018 fitted with customized SPOT scleral lenses. We assessed the best-corrected visual acuity (BCVA) before and after fitting with SPOT, keratometric data and tolerability of the scleral lenses. RESULTS: Nine eyes of 5 patients aged 51.8±8.47 years were fitted. The BCVA was significantly improved from 0.51 logMAR (±0.39) to 0.04 logMAR (±0.07) (P<0.001). Sixty-six percent of the patients recovered optimal BCVA. No serious adverse event was reported. The presence of whitish deposits and an inordinate amount of manipulation required were the main disadvantages of the lenses. Nevertheless, all the patients considered them to be comfortable. CONCLUSION: Fitting PMD patients who have failed conventional optical devices with SPOT scleral lenses significantly improves BCVA, without serious adverse events, allowing surgery to be deferred even when it appears to be unavoidable.

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