Since the introduction of so-called less-lethal weapons in France in the late 1990s, there has been no legal requirement to collect data on injuries induced by kinetic impact projectiles, and no ...epidemiological surveys have been planned. To estimate the number of patients with ocular injuries caused by the use of these defensive tools, a retrospective survey was sent to all ophthalmology department chairs in French university hospitals, which are where the most severe cases are managed. Demographic data, date of trauma, initial ophthalmological examination and any specialised investigations, initial and immediate surgical management of the injury, follow-up, and visual prognosis were documented and transmitted anonymously.We compiled data from patients seen between February, 2016, and August, 2019 (figure). 43 cases were identified, of which 20 (47%) were managed in Paris. The cases included 38 men and five women, with a median age of 26 years (range 15–59).
Intracranial aneurysms (IAs) are acquired cerebrovascular abnormalities characterized by localized dilation and wall thinning in intracranial arteries, possibly leading to subarachnoid hemorrhage and ...severe outcome in case of rupture. Here, we identified one rare nonsense variant (c.1378A>T) in the last exon of ANGPTL6 (Angiopoietin-Like 6)—which encodes a circulating pro-angiogenic factor mainly secreted from the liver—shared by the four tested affected members of a large pedigree with multiple IA-affected case subjects. We showed a 50% reduction of ANGPTL6 serum concentration in individuals heterozygous for the c.1378A>T allele (p.Lys460Ter) compared to relatives homozygous for the normal allele, probably due to the non-secretion of the truncated protein produced by the c.1378A>T transcripts. Sequencing ANGPTL6 in a series of 94 additional index case subjects with familial IA identified three other rare coding variants in five case subjects. Overall, we detected a significant enrichment (p = 0.023) in rare coding variants within this gene among the 95 index case subjects with familial IA, compared to a reference population of 404 individuals with French ancestry. Among the 6 recruited families, 12 out of 13 (92%) individuals carrying IA also carry such variants in ANGPTL6, versus 15 out of 41 (37%) unaffected ones. We observed a higher rate of individuals with a history of high blood pressure among affected versus healthy individuals carrying ANGPTL6 variants, suggesting that ANGPTL6 could trigger cerebrovascular lesions when combined with other risk factors such as hypertension. Altogether, our results indicate that rare coding variants in ANGPTL6 are causally related to familial forms of IA.
Objective:
We describe a clinico-radiological presentation of inflammatory optic neuropathy that mimicked optic neuritis.
Methods:
Retrospective single-center case series and literature review of ...optic neuropathy without orbital pseudotumor.
Results:
Five local patients fulfilled the inclusion criteria. Clinical presentation revealed rapidly progressive severe unilateral visual loss, retrobulbar pain (n = 4), and paralytic strabismus (simultaneous = 2, protracted = 2) without proptosis. Optic nerve abnormality was not appreciated on initial scan review. Patients did not have any general activity of the granulomatosis with polyangiitis. Upon follow-up magnetic resonance imaging and initial imaging review, all patients revealed orbital apex anomalies. Visual acuity improved in three patients who received high-dose intravenous glucocorticosteroids immediately. Relapse was frequent and visual outcome was poor (final vision > 20/40 in two patients only). Literature review identified 16 well-documented cases of granulomatosis with polyangiitis–related isolated optic neuropathies. Magnetic resonance imaging revealed no abnormality (n = 6), optic nerve and/or sheath involvement (n = 9), apex infiltration (n = 3), and/or pachymeningitis (n = 7).
Conclusion:
Granulomatosis with polyangiitis is a rare yet potentially blinding cause of inflammatory optic neuropathy. Optic neuropathy in granulomatosis with polyangiitis may occur in the absence of systemic symptoms of disease activity and is challenging to distinguish from other inflammatory and non-inflammatory disorders affecting visual acuity. Several clinical and imaging clues suggest that optic neuropathy results from the development of an extravascular granulomatous process within the optic nerve sheath in the orbital apex, a place that is difficult to image. In a granulomatosis with polyangiitis patient with unexplained visual loss and a seemingly normal workup (fundoscopy, biology, and imaging), clinician should keep a high index of suspicion.
The time course of neural activity in human brain regions involved in mediating pursuit eye movements is unclear. To address this question, we recorded intracerebral electroencephalography activity ...in eight epileptic patients while they performed a pursuit task that dissociates reactive, predictive and inhibited pursuits. A sustained gamma band (50–150Hz) activity corresponding to pursuit maintenance was observed in the pursuit (and not saccade) area of the frontal eye field (FEF), in the ventral intraparietal sulcus (VIPS) and in occipital areas. The latency of gamma increase was found to precede target onset in FEF and VIPS, suggesting that those areas could also be involved during pursuit preparation/initiation. During pursuit inhibition, a sustained gamma band response was observed within prefrontal areas (pre-supplementary-motor-area, dorso-lateral prefrontal and frontopolar cortex). This study describes for the first time the dynamics of the neural activity in four areas of the pursuit system, not previously available in humans. These findings provide novel timing constraints to current models of the human pursuit system and establish the relevance of direct recordings to precisely relate eye movement behavior with neural activity in humans.
► First electrophysiological evidence of pursuit and saccade subregions in human FEF ► Gamma band time course dissociate pursuit components ► Pursuit inhibition induced an increase of prefrontal gamma power.
Purpose
To measure the predictive values of relative afferent pupillary defect (RAPD) assessed semi‐quantitatively, and visual acuity (VA) at onset of central retinal vein occlusion (CRVO), for ...neovascularization.
Methods
Retrospective analysis of the TROXHEMO trial that included patients with CRVO within 30 days after the onset. Inclusion criteria were as follows: semi‐quantitative RAPD assessment at diagnosis and/or at one month. RAPD was ‘severe’ if ≥ 0.9 log. Exclusion criteria were as follows: prophylactic panretinal photocoagulation (PRP) before neovascularization.
Results
Among the 119 patients enrolled in the main centre, 101 were analysed. 26 had a neovascular complication during the twelve months of follow‐up: rubeosis (19), glaucoma (7) and posterior neovascularization (15). The mean time to onset of a neovascular complication was 4.7 months (1 to 12, median 3 months). All the patients who had a neovascular complication had RAPD at first examination or at one month (negative predictive value (NPV) = 100%) but the positive predictive value (PPV) was low (31%, 95% CI 21%; 42%). The association ‘severe RAPD or VA < 35 letters (ETDRS) at inclusion or at one month’ was the best compromise between PPV (53%, 39%; 68%) and NPV (96%, 92%; 100%).
Conclusion
To predict neovascularization, RAPD should be routinely evaluated with filters: the risk of neovascular complication is (a) almost nil if there is no RAPD, (b) very low if there is no severe RAPD and if VA is higher than 35 letters, and (c) higher than 50% if RAPD is ≥ 0.9 log or if VA is less than 35 letters.
Background
Although acute central retinal artery occlusion is as a stroke in the carotid territory (retinal artery), its management remains controversial. The aim of this study was to assess the ...feasibility and safety of intravenous thrombolysis delivered within 6 h of central retinal artery occlusion in French stroke units.
Methods
We performed a retrospective analysis of patients treated with intravenous alteplase (recombinant tissue-plasminogen activator), based on stroke units thrombolysis registers from June 2005 to June 2015, and we selected those who had acute central retinal artery occlusion. The feasibility was assessed by the ratio of patients that had received intravenous alteplase within 6 h after central retinal artery occlusion onset among those who had been admitted to the same hospital for acute central retinal artery occlusion. All adverse events were documented.
Results
Thirty patients were included. Visual acuity before treatment was limited to “hand motion”, or worse, in 90% of the cases. The mean onset-to-needle time was 273 min. The individuals treated with intravenous alteplase for central retinal artery occlusion represented 10.2% of all of the patients hospitalized for central retinal artery occlusion in 2013 and 2014. We observed one occurrence of major bleeding, a symptomatic intracerebral hemorrhage.
Conclusion
When applied early on, intravenous thrombolysis appears to be feasible and safe, provided that contraindications are given due consideration. Whether intravenous thrombolysis is more effective than conservative therapy remains to be determined. In order to conduct a well-designed prospective randomized control trial, an organized network should be in place.
Purpose:
To date, no protocol of anesthesia for pediatric ophthalmic surgery is unanimously recognized. The primary anesthetic risks are associated with strabismus surgery, including oculocardiac ...reflex, postoperative nausea and vomiting, and postoperative pain.
Methods:
This was a prospective, monocentric, observational study conducted in a tertiary pediatric ophthalmic unit. Our anesthetic protocol for strabismus surgery included postoperative nausea and vomiting prevention using dexamethasone and ondansetron. No drug-based prevention of oculocardiac reflex or local/locoregional anesthesia was employed.
Results:
A total of 106 pediatric ophthalmic surgeries completed between November 2015 and May 2016 were analyzed. The mean patient age was 4.4 (range: 0.2–7.3, standard deviation: 2.4) years. Ambulatory rate was 90%. Oculocardiac reflex incidence was 65% during strabismus surgery (34/52), 50% during congenital cataract surgery (4/8), 33% during intramuscular injection of botulinum toxin (1/3), and 0% during other procedures. No asystole occurred. Postoperative nausea and vomiting incidence was 9.6% after strabismus surgery (5/52) and 0% following the other procedures. One child was hospitalized for one night because of persistent postoperative nausea and vomiting. Postoperative pain generally occurred early on in the recovery room and was quickly controlled. Its incidence was higher in patients who underwent strabismus surgery (27%) than in those who underwent other procedures (9%).
Conclusion:
Morbidity associated with ophthalmic pediatric surgery is low and predominantly associated with strabismus surgery. The benefit–risk ratio and cost-effectiveness of oculocardiac reflex prevention should be questioned. Our postoperative nausea and vomiting rate is low, thanks to the use of a well-managed multimodal strategy. Early postoperative pain is usually well-treated but could probably be more effectively prevented.
This study aims at understanding the effects of homogeneous visual field defects on ocular movements and exploratory patterns according to their peripheral or central location. A gaze-contingent ...paradigm was implemented in order to display images to the participants while masking in
real-time either central or peripheral areas of the participant's field of view. Results indicate a strong relation between saccade amplitudes and mask sizes. Fixations are predominantly directed toward parts of the scene which are left unmasked. In a second set of analyses, we defined relative
angle as an angle between a saccade vector and a preceding one. We show that backward saccades are more frequently produced with central masking. As for peripheral masking, we observe that participants explore the scene in a sequential scanning pattern seldom foveating back to an area attended
in the previous seconds. We discuss how masking conditions affect ocular behaviours in terms of exploratory patterns, as well as how relative angles unveil characteristic information distinguishing the two masking conditions from each other and from control subjects.
A smooth pursuit eye movement (SPEM) deficit differs according to the location of the focal lesion.1 Occipitoparietal lesions induce craniotopic deficits, with slower SPEM velocity in the ...contralateral hemifield. A lesion to the frontal eye field (FEF) induces an ipsiversive defect, with decreased SPEM velocity when the eye is moved toward the side of the lesion, regardless of the hemifield. Direct human intracerebral EEG (iEEG) of 2 patients with epilepsy during pursuit revealed a specific increase in broadband gamma high-frequency activity (HFA) (50-150 Hz) in the cuneus and FEF.2 By analyzing the neural activity according to pursuit direction, we highlight how cortical SPEM areas use different referential frameworks to code eye movement.
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