Frédéric Mura - Academia.edu (original) (raw)

Papers by Frédéric Mura

Research paper thumbnail of Prise en charge diagnostique des uvéites (intérêt d'une approche bidisciplinaire)

MONTPELLIER-BU Médecine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocMONTPELLIER-BU Médec... more MONTPELLIER-BU Médecine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Research paper thumbnail of Sarcoidose et Oeil. SFO. pdf

Research paper thumbnail of Melanoma-associated retinopathy during pembrolizumab treatment probably controlled by intravitreal injections of dexamethasone

Documenta Ophthalmologica, 2020

Purpose Melanoma-associated retinopathy (MAR) is a rare paraneoplastic syndrome due to antibodies... more Purpose Melanoma-associated retinopathy (MAR) is a rare paraneoplastic syndrome due to antibodies targeting bipolar retinal cells. Its evolution, particularly in patients treated with immune checkpoint inhibitors (ICI), is currently poorly understood. In the few cases published, patients’ visual function got worse when these molecules were prescribed. Here, we present a case of a patient with severe MAR treated with an ICI for melanoma progression. Methods A 68-year-old woman with a history of melanoma of the palpebral conjunctiva presented with sudden and gradually worsening visual disturbances. Simultaneously, a metastatic evolution of the melanoma was diagnosed and surgically treated exclusively. Visual acuity assessment, static automated perimetry and ERG results lead to the diagnosis of MAR. Since systemic corticosteroid therapy did not improve her symptoms, repeated intraocular corticosteroid injections were performed with a positive outcome. Later on, metastatic progression of the patient’s melanoma led to the introduction of pembrolizumab, an ICI targeting PD-1. Immunotherapy has changed the prognosis of patient affected by metastatic melanoma, but these molecules may induce various immune-related adverse effects. In our case, intraocular corticosteroid injections were still performed simultaneously. Visual acuity assessment, static automated perimetry and ERG were performed during the course of this treatment. Results Full-field ERGs results suggested the possibility that the ophthalmologic treatment might restore the patient’s retinal function despite the continued immunotherapy. Conclusion We report the first case of MAR with a positive outcome after 1 year of ICI, possibly thanks to intravitreal corticosteroid therapy.

Research paper thumbnail of Uvéites et déficit immunitaire commun variable : données de la cohorte DEF-I

La Revue de Médecine Interne, 2010

Communications orales / La Revue de médecine interne 31S (2010) S35-S83 Conclusion.-Contrairement... more Communications orales / La Revue de médecine interne 31S (2010) S35-S83 Conclusion.-Contrairement à la notion classiquement rapportée, les mutations C282Y et H63D à l'état hétérozygote sont significativement associées à l'hyperferritinémie idiopathique, et il s'agit à notre connaissance de la première mise en évidence de la traduction phénotypique de ces anomalies génétiques. L'impact de ces mutations en termes de traduction clinique et de pronostic reste à identifier à l'avenir dans le suivi de ces patients.

Research paper thumbnail of Exophthalmos, Diplopia, and Bilateral Eyelid Edema: Symptoms of Ocular Mastocytosis

Optometry and vision science : official publication of the American Academy of Optometry, Jan 24, 2016

Mastocytosis is characterized by clonal mast cell proliferation with accumulation within various ... more Mastocytosis is characterized by clonal mast cell proliferation with accumulation within various organs and uncontrolled activation with excessive mast cell mediator release. Ocular manifestations have rarely been published. We describe a 63-year-old man with bilateral exophthalmos that led to the diagnosis of systemic mastocytosis. A patient presented with bilateral eyelid edema with exophthalmos associated with binocular diplopia. Ophthalmologic examination showed bilateral axial, symmetrical, and painless exophthalmos with eyelid edema, and limitation in elevation of the right eye. Visual acuity was normal. Orbital magnetic resonance imaging showed increased volume of both the superior and medial recti muscles and right inferior oblique muscle, and histopathological examination of orbital fat and muscle biopsies revealed an infiltration by mast cells. Serum tryptase was elevated. The patient also complained of a long history of pruritis and diffuse skin erythema that could be eli...

Research paper thumbnail of Th17 and regulatory T cells are increased in blood of patients with birdshot chorioretinopathy

Acta ophthalmologica, Jan 24, 2016

Research paper thumbnail of Vogt-koyanagi-harada syndrome associated with psoriasis and autoimmune thyroid disease

Acta dermato-venereologica, 2008

Research paper thumbnail of Psychiatric disorders in Behçet’s disease : multicentric and retrospective study of 161 patients

Neuro-psychiatric involvement is among the most severe and disabling complications of Behçet'... more Neuro-psychiatric involvement is among the most severe and disabling complications of Behçet's disease (BD). Recently, revised criteria for the diagnosis of neuro-BD (NBD) have been published. Although psychosis was retained in NBD criteria, all the other psychiatric manifestations, e.g., depression, were not considered being part of NBD (1). The frequency with which psychiatric disorders, and especially depression, occur in BD is a debated issue. The aim of our study is to evaluate the frequency and the characteristics of psychiatric disorders in BD. Methods One hundred and sixty one patients, who fulfilled the 2013 International Criteria for Behçet's Disease (ICBD), were retrospectively studied. Psychiatric disorders were defined either based on a diagnosis made by a psychiatrist or a psychotropic medication maintained for more than 3 months. We performed a comparative analysis of 25 demographic, clinical, imaging and laboratory features between patients with ("psychi...

Research paper thumbnail of Uvéites syphilitiques aspects cliniques et épidémiologiques à propos d'une série monocentrique de sept cas

La Revue de Médecine Interne, 2006

Research paper thumbnail of Simultaneous occurrence of generalized granuloma annulare, anterior uveitis and giant cell arteritis: Coincidental or not?

La Presse Médicale, 2012

Déclaration d'intérêts : les auteurs déclarent ne pas avoir de conflits d'intérêts en relation av... more Déclaration d'intérêts : les auteurs déclarent ne pas avoir de conflits d'intérêts en relation avec cet article.

Research paper thumbnail of Uvéite intermédiaire corticorésistante : pensez à l’amylose

La Revue de Médecine Interne, 2011

Communications affichées / La Revue de médecine interne 32S (2011) S99-S191

Research paper thumbnail of Bartonellose oculaire chez une patiente co-infectée VIH–VHC

Médecine et Maladies Infectieuses, 2008

Natural orifice translumenal endoscopic surgery (NO TES) training is unique in that it crosses sp... more Natural orifice translumenal endoscopic surgery (NO TES) training is unique in that it crosses specialty lines and most practitioners do not possess both the kn owledge and skill to perform the procedures in their current form. The learning process becomes even more complex because the field is in constant evolution with advances in technology and technique being introduced almost daily! The challenges of learning NOTES illustrates a larger problem in all procedurally based medical spec ialties todaythe pace of change has become so rapid that a practicing physician's technical skills become out of date within five to ten years of completing residency or fellowship training. As a result, practicing physicians must develop a strategy to rapidly learn about a new technique or technology and introduce it safely into their practice while satisfying the concerns of their hospital's credentialing committee. This chapter will explore the options for learning new procedures and discuss the rapidly expanding armamentarium of education institutes and the developing technology to measure procedural competence.

Research paper thumbnail of Ipsilateral Uveitis and Optic Neuritis in Multiple Sclerosis

Multiple Sclerosis International, 2012

Background. Uveitis is 20 times more frequent in multiple sclerosis (MS) patients than in the gen... more Background. Uveitis is 20 times more frequent in multiple sclerosis (MS) patients than in the general population.Methods. A retrospective study of local multiple sclerosis(n=700)and uveitis cohorts(n=450)described the ophthalmological and neurological characteristics of patients with multiple sclerosis and uveitis.Results. Uveitis and multiple sclerosis were associated in seven patients. The time intervals between diagnoses of MS and uveitis ranged from 6 months to 15 years. Analysis of the patients’ characteristics revealed that multiple sclerosis was associated with an older age of onset than usually expected, that is, 39 years. Uveitis was bilateral in three cases and mainly posterior (5/10). Five patients presented with acute optic neuritis (two in one eye and three in both eyes). All eyes presenting with acute optic neuritis were also affected by uveitis(P=0.02), though not simultaneously.Conclusion. The ipsilateral association between optic neuritis and uveitis in this series ...

Research paper thumbnail of Uveitis and Common Variable Immunodeficiency: Data from the DEF-I Study And Literature Review

Ocular Immunology and Inflammation, 2012

To examine the relation between uveitis and common variable immunodeficiency (CVID). Retrospectiv... more To examine the relation between uveitis and common variable immunodeficiency (CVID). Retrospective analysis of patients included in the French DEFI cohort of adults with CVID and of patients identified by reviewing the literature. Four patients were identified in the DEFI study (frequency of uveitis: 1.6%). The course of uveitis was not changed in the patients who started intravenous immunoglobulins replacement therapy after CVID diagnosis. Ten cases of CVID-associated uveitis were listed in the literature. Overall, among the 14 patients, uveitis was always chronic, usually bilateral (n = 11) and granulomatous (n = 9). Seven patients presented with a "sarcoid-likeâ syndrome. Nine patients had granulomatous uveitis suggestive of ocular sarcoidosis. Five patients were treated with local corticosteroids, and 9 required systemic treatment (corticosteroids alone n = 5 and/or immunosuppressive agents n = 4). CVID can be associated with uveitis. Since uveitis can reveal the immunodeficiency, CVID diagnosis should be considered at the time of uveitis diagnosis.

Research paper thumbnail of Susac's syndrome, a rare, potentially severe or lethal neurological disease

Journal of the Neurological Sciences, 2010

Susac's syndrome (SS) is a rare, immune-mediated endotheliopathy affecting the microvascu... more Susac's syndrome (SS) is a rare, immune-mediated endotheliopathy affecting the microvasculature of the brain, the inner ear and the retina. Clinical presentation is characterised by a triad: encephalopathy, hearing loss and branch retinal artery occlusion (BRAO). Given the rarity of this disease, its natural history still remains partially unknown, but lethal cases appear to be extremely rare since there has never been, to our knowledge, a report of SS leading to death. We report 2 cases of SS illustrating the multiplicity of neurological symptomatology and its unpredictable course. One case is particularly unusual due to its severe neurological evolution, leading to death despite treatments. This report presents clinical and paraclinical findings contributory to SS diagnosis and offers an innovative perspective on disease management. These cases represent the potential severity of this disease. Early, aggressive treatment strategies may be warranted for SS in order to avoid neurological deterioration and lethal evolution.

Research paper thumbnail of 041 Traitement par anti-TNF dans les uvéites associées à l’arthrite juvénile idiopathique : à propos de 8 cas

Journal Français d'Ophtalmologie, 2008

ABSTRACT

Research paper thumbnail of 688 Hypertension intracrânienne idiopathique : évaluation d’une procédure diagnostique et thérapeutique pour établir un référentiel pratique devant un œdème papillaire bilatéral

Journal Français d'Ophtalmologie, 2008

Introduction L’hypertension intracrânienne idiopathique (HICi) est une pathologie rare, dont le d... more Introduction L’hypertension intracrânienne idiopathique (HICi) est une pathologie rare, dont le diagnostic repose sur la presence d’un œdeme papillaire, d’une imagerie neuroradiologique normale, une pression intracrânienne (PIC) elevee avec un LCR normal. Nous avons defini des criteres diagnostiques et une strategie therapeutique pour tout patient presentant des signes evocateurs d’HICi et avons evalue la faisabilite de ce protocole ainsi que l’evolution de la fonction visuelle. Objectifs et Methodes Devant un œdeme papillaire bilateral sans cause intra-oculaire ou ischemique, la demarche diagnostique etait : examen ophtalmologique, champ visuel, Lancaster, angio-scanner et/ou IRM, angiographie fluoresceinique, mesure de la PIC avec analyse biologique du LCR. Le diagnostic d’HICi pose, la demarche therapeutique reposait sur la severite de l’atteinte fonctionnelle sur au moins 1 œil. De 7 a 10/10, acetazolamide per os et controle a J15. Pour les autres patients, bolus de corticoides et acetazolamide sur 3 a 5 jours (Liu et Glaser) ; l’absence d’amelioration fonctionnelle significative conduisait a discuter l’ouverture chirurgicale des meninges peri-optiques. Chez les patients ameliores sur au moins 1 œil, l’acetazolamide seul etait poursuivi. Resultats Notre travail a porte sur 34 dossiers. La mise en evidence de paresies infra-cliniques du VI, l’existence d’une selle turcique vide, sont des anomalies souvent observees et renforcant la presomption diagnostique d’HICi. Tous les patients ont ete traites par acetazolamide. Moins de 20 % ont necessite des bolus de corticoides. Moins de 5 % ont ete traites chirurgicalement. L’amelioration ou la stabilisation de la fonction visuelle ont ete obtenues pour plus de 80 % des patients a 6 mois du diagnostic. Discussion Le diagnostic repose sur un faisceau d’arguments cliniques, radiologiques et sur la PIC ; chaque etape est contributive au diagnostic d’HICi. La multidisciplinarite de la prise en charge diagnostique de l’HICi dans un contexte d’urgence impose un referentiel codifie pour instaurer rapidement le traitement le mieux adapte a la severite de la neuropathie optique. Conclusion L’HICi demeure un diagnostic d’elimination qui requiert une procedure diagnostique associant ophtalmologiste, radiologue, neurologue. La rapidite de la strategie diagnostique et therapeutique permet d’ameliorer ou de stabiliser la grande majorite des patients.

Research paper thumbnail of 602 Évaluation de la prise en charge thérapeutique des uvéites liées à l’antigène HLA B27 : étude rétrospective sur 94 patients

Journal Français d'Ophtalmologie, 2008

1S186 délétère après boli. Après étude statistique, aucune réaction inflammatoire ni facteur de r... more 1S186 délétère après boli. Après étude statistique, aucune réaction inflammatoire ni facteur de risque, en particulier dans le groupe C, n'étaient significatifs. Discussion : Plusieurs protocoles ont été proposés dans les cataractes post-uvéitiques. Le boli par MPS est disponible, rapide et efficace. Conclusion : Le boli péri-opératoire de MPS a permis pour les yeux uvéitiques opérés de cataracte, une maîtrise de l'inflammation. Des études plus larges randomisées permettraient de confirmer ces résultats, et mieux définir les groupes « à haut risque » dans la chirurgie des yeux uvéitiques. 602 Évaluation de la prise en charge thérapeutique des uvéites liées à l'antigène HLA B27 : étude rétrospective sur 94 patients. Treatment in HLA B27 uveitis: retrospective study of 94 patients.

Research paper thumbnail of 280 À propos de deux cas de TINU syndrome

Journal Français d'Ophtalmologie, 2007

Introduction Le TINU syndrome (Tubulo Interstitial Nephritis and Uveitis syndrome) est une etiolo... more Introduction Le TINU syndrome (Tubulo Interstitial Nephritis and Uveitis syndrome) est une etiologie rare d’uveite, classiquement anterieure et bilaterale, dont la gravite potentielle impose un diagnostic precoce afin de ne pas retarder la mise en route du traitement general adapte. L’atteinte du segment posterieur, plus rarement decrite, apparait cependant comme un element de gravite supplementaire a connaitre. Objectifs et Methodes Nous presentons deux cas de TINU syndrome diagnostiques lors d’une poussee d’uveite aigue. Un adolescent de 16 ans et une femme de 39 ans caucasiens ont presente une uveite anterieure aigue bilaterale respectivement 6 et 12 mois apres le debut d’une nephrite tubulo-interstitielle idiopathique, lors d’une baisse de palier a 10 mg de prednisolone. Leur presentation clinique initiale etait proche, caracterisee par une photophobie, des douleurs, une hyperhemie conjonctivale, une baisse d’acuite visuelle moderee, un tyndall cellulaire important, des synechies irido-cristalliniennes, ainsi qu’une hyalite. L’adolescent a par ailleurs developpe une papillite bilaterale des la premiere semaine. Le recours a une corticotherapie generale a 1 mg/kg/j s’est rapidement impose et l’evolution s’est etalee sur plus de 6 mois avec une relative corticodependance. Discussion Le TINU syndrome est decrit depuis 1975, touchant les adultes jeunes ou les adolescents, avec une predominance feminine. Dans les cas presentes, l’atteinte renale precedait l’uveite avec une stabilite de la fonction renale au cours de l’episode oculaire, l’acuite visuelle etait relativement conservee, l’inflammation oculaire a ete lentement controlee par la corticotherapie. L’atteinte posterieure, plus inhabituelle reste un facteur pronostique a rechercher systematiquement. Conclusion Le ionogramme sanguin et la bandelette urinaire font partie integrante du bilan d’uveite. De meme, a l’occasion d’une nephrite tubulo-interstitielle idiopathique, l’ophtalmologiste permet de classer cette derniere en TINU Syndrome. Bien que rare, il faut savoir reconnaitre ce syndrome rapidement car il peut necessiter une corticotherapie soutenue, meme si l’atteinte renale est en remission. De plus, tous les segments oculaires peuvent etre touches. Le TINU syndrome illustre parfaitement la necessite d’une approche multidisciplinaire dans la prise en charge des uveites.

Research paper thumbnail of 292 Optimisation de la prise en charge des uvéites par une approche bidisciplinaire : pourquoi ? Comment ?

Journal Français d'Ophtalmologie, 2005

Research paper thumbnail of Prise en charge diagnostique des uvéites (intérêt d'une approche bidisciplinaire)

MONTPELLIER-BU Médecine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocMONTPELLIER-BU Médec... more MONTPELLIER-BU Médecine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Research paper thumbnail of Sarcoidose et Oeil. SFO. pdf

Research paper thumbnail of Melanoma-associated retinopathy during pembrolizumab treatment probably controlled by intravitreal injections of dexamethasone

Documenta Ophthalmologica, 2020

Purpose Melanoma-associated retinopathy (MAR) is a rare paraneoplastic syndrome due to antibodies... more Purpose Melanoma-associated retinopathy (MAR) is a rare paraneoplastic syndrome due to antibodies targeting bipolar retinal cells. Its evolution, particularly in patients treated with immune checkpoint inhibitors (ICI), is currently poorly understood. In the few cases published, patients’ visual function got worse when these molecules were prescribed. Here, we present a case of a patient with severe MAR treated with an ICI for melanoma progression. Methods A 68-year-old woman with a history of melanoma of the palpebral conjunctiva presented with sudden and gradually worsening visual disturbances. Simultaneously, a metastatic evolution of the melanoma was diagnosed and surgically treated exclusively. Visual acuity assessment, static automated perimetry and ERG results lead to the diagnosis of MAR. Since systemic corticosteroid therapy did not improve her symptoms, repeated intraocular corticosteroid injections were performed with a positive outcome. Later on, metastatic progression of the patient’s melanoma led to the introduction of pembrolizumab, an ICI targeting PD-1. Immunotherapy has changed the prognosis of patient affected by metastatic melanoma, but these molecules may induce various immune-related adverse effects. In our case, intraocular corticosteroid injections were still performed simultaneously. Visual acuity assessment, static automated perimetry and ERG were performed during the course of this treatment. Results Full-field ERGs results suggested the possibility that the ophthalmologic treatment might restore the patient’s retinal function despite the continued immunotherapy. Conclusion We report the first case of MAR with a positive outcome after 1 year of ICI, possibly thanks to intravitreal corticosteroid therapy.

Research paper thumbnail of Uvéites et déficit immunitaire commun variable : données de la cohorte DEF-I

La Revue de Médecine Interne, 2010

Communications orales / La Revue de médecine interne 31S (2010) S35-S83 Conclusion.-Contrairement... more Communications orales / La Revue de médecine interne 31S (2010) S35-S83 Conclusion.-Contrairement à la notion classiquement rapportée, les mutations C282Y et H63D à l'état hétérozygote sont significativement associées à l'hyperferritinémie idiopathique, et il s'agit à notre connaissance de la première mise en évidence de la traduction phénotypique de ces anomalies génétiques. L'impact de ces mutations en termes de traduction clinique et de pronostic reste à identifier à l'avenir dans le suivi de ces patients.

Research paper thumbnail of Exophthalmos, Diplopia, and Bilateral Eyelid Edema: Symptoms of Ocular Mastocytosis

Optometry and vision science : official publication of the American Academy of Optometry, Jan 24, 2016

Mastocytosis is characterized by clonal mast cell proliferation with accumulation within various ... more Mastocytosis is characterized by clonal mast cell proliferation with accumulation within various organs and uncontrolled activation with excessive mast cell mediator release. Ocular manifestations have rarely been published. We describe a 63-year-old man with bilateral exophthalmos that led to the diagnosis of systemic mastocytosis. A patient presented with bilateral eyelid edema with exophthalmos associated with binocular diplopia. Ophthalmologic examination showed bilateral axial, symmetrical, and painless exophthalmos with eyelid edema, and limitation in elevation of the right eye. Visual acuity was normal. Orbital magnetic resonance imaging showed increased volume of both the superior and medial recti muscles and right inferior oblique muscle, and histopathological examination of orbital fat and muscle biopsies revealed an infiltration by mast cells. Serum tryptase was elevated. The patient also complained of a long history of pruritis and diffuse skin erythema that could be eli...

Research paper thumbnail of Th17 and regulatory T cells are increased in blood of patients with birdshot chorioretinopathy

Acta ophthalmologica, Jan 24, 2016

Research paper thumbnail of Vogt-koyanagi-harada syndrome associated with psoriasis and autoimmune thyroid disease

Acta dermato-venereologica, 2008

Research paper thumbnail of Psychiatric disorders in Behçet’s disease : multicentric and retrospective study of 161 patients

Neuro-psychiatric involvement is among the most severe and disabling complications of Behçet'... more Neuro-psychiatric involvement is among the most severe and disabling complications of Behçet's disease (BD). Recently, revised criteria for the diagnosis of neuro-BD (NBD) have been published. Although psychosis was retained in NBD criteria, all the other psychiatric manifestations, e.g., depression, were not considered being part of NBD (1). The frequency with which psychiatric disorders, and especially depression, occur in BD is a debated issue. The aim of our study is to evaluate the frequency and the characteristics of psychiatric disorders in BD. Methods One hundred and sixty one patients, who fulfilled the 2013 International Criteria for Behçet's Disease (ICBD), were retrospectively studied. Psychiatric disorders were defined either based on a diagnosis made by a psychiatrist or a psychotropic medication maintained for more than 3 months. We performed a comparative analysis of 25 demographic, clinical, imaging and laboratory features between patients with ("psychi...

Research paper thumbnail of Uvéites syphilitiques aspects cliniques et épidémiologiques à propos d'une série monocentrique de sept cas

La Revue de Médecine Interne, 2006

Research paper thumbnail of Simultaneous occurrence of generalized granuloma annulare, anterior uveitis and giant cell arteritis: Coincidental or not?

La Presse Médicale, 2012

Déclaration d'intérêts : les auteurs déclarent ne pas avoir de conflits d'intérêts en relation av... more Déclaration d'intérêts : les auteurs déclarent ne pas avoir de conflits d'intérêts en relation avec cet article.

Research paper thumbnail of Uvéite intermédiaire corticorésistante : pensez à l’amylose

La Revue de Médecine Interne, 2011

Communications affichées / La Revue de médecine interne 32S (2011) S99-S191

Research paper thumbnail of Bartonellose oculaire chez une patiente co-infectée VIH–VHC

Médecine et Maladies Infectieuses, 2008

Natural orifice translumenal endoscopic surgery (NO TES) training is unique in that it crosses sp... more Natural orifice translumenal endoscopic surgery (NO TES) training is unique in that it crosses specialty lines and most practitioners do not possess both the kn owledge and skill to perform the procedures in their current form. The learning process becomes even more complex because the field is in constant evolution with advances in technology and technique being introduced almost daily! The challenges of learning NOTES illustrates a larger problem in all procedurally based medical spec ialties todaythe pace of change has become so rapid that a practicing physician's technical skills become out of date within five to ten years of completing residency or fellowship training. As a result, practicing physicians must develop a strategy to rapidly learn about a new technique or technology and introduce it safely into their practice while satisfying the concerns of their hospital's credentialing committee. This chapter will explore the options for learning new procedures and discuss the rapidly expanding armamentarium of education institutes and the developing technology to measure procedural competence.

Research paper thumbnail of Ipsilateral Uveitis and Optic Neuritis in Multiple Sclerosis

Multiple Sclerosis International, 2012

Background. Uveitis is 20 times more frequent in multiple sclerosis (MS) patients than in the gen... more Background. Uveitis is 20 times more frequent in multiple sclerosis (MS) patients than in the general population.Methods. A retrospective study of local multiple sclerosis(n=700)and uveitis cohorts(n=450)described the ophthalmological and neurological characteristics of patients with multiple sclerosis and uveitis.Results. Uveitis and multiple sclerosis were associated in seven patients. The time intervals between diagnoses of MS and uveitis ranged from 6 months to 15 years. Analysis of the patients’ characteristics revealed that multiple sclerosis was associated with an older age of onset than usually expected, that is, 39 years. Uveitis was bilateral in three cases and mainly posterior (5/10). Five patients presented with acute optic neuritis (two in one eye and three in both eyes). All eyes presenting with acute optic neuritis were also affected by uveitis(P=0.02), though not simultaneously.Conclusion. The ipsilateral association between optic neuritis and uveitis in this series ...

Research paper thumbnail of Uveitis and Common Variable Immunodeficiency: Data from the DEF-I Study And Literature Review

Ocular Immunology and Inflammation, 2012

To examine the relation between uveitis and common variable immunodeficiency (CVID). Retrospectiv... more To examine the relation between uveitis and common variable immunodeficiency (CVID). Retrospective analysis of patients included in the French DEFI cohort of adults with CVID and of patients identified by reviewing the literature. Four patients were identified in the DEFI study (frequency of uveitis: 1.6%). The course of uveitis was not changed in the patients who started intravenous immunoglobulins replacement therapy after CVID diagnosis. Ten cases of CVID-associated uveitis were listed in the literature. Overall, among the 14 patients, uveitis was always chronic, usually bilateral (n = 11) and granulomatous (n = 9). Seven patients presented with a "sarcoid-likeâ syndrome. Nine patients had granulomatous uveitis suggestive of ocular sarcoidosis. Five patients were treated with local corticosteroids, and 9 required systemic treatment (corticosteroids alone n = 5 and/or immunosuppressive agents n = 4). CVID can be associated with uveitis. Since uveitis can reveal the immunodeficiency, CVID diagnosis should be considered at the time of uveitis diagnosis.

Research paper thumbnail of Susac's syndrome, a rare, potentially severe or lethal neurological disease

Journal of the Neurological Sciences, 2010

Susac's syndrome (SS) is a rare, immune-mediated endotheliopathy affecting the microvascu... more Susac's syndrome (SS) is a rare, immune-mediated endotheliopathy affecting the microvasculature of the brain, the inner ear and the retina. Clinical presentation is characterised by a triad: encephalopathy, hearing loss and branch retinal artery occlusion (BRAO). Given the rarity of this disease, its natural history still remains partially unknown, but lethal cases appear to be extremely rare since there has never been, to our knowledge, a report of SS leading to death. We report 2 cases of SS illustrating the multiplicity of neurological symptomatology and its unpredictable course. One case is particularly unusual due to its severe neurological evolution, leading to death despite treatments. This report presents clinical and paraclinical findings contributory to SS diagnosis and offers an innovative perspective on disease management. These cases represent the potential severity of this disease. Early, aggressive treatment strategies may be warranted for SS in order to avoid neurological deterioration and lethal evolution.

Research paper thumbnail of 041 Traitement par anti-TNF dans les uvéites associées à l’arthrite juvénile idiopathique : à propos de 8 cas

Journal Français d'Ophtalmologie, 2008

ABSTRACT

Research paper thumbnail of 688 Hypertension intracrânienne idiopathique : évaluation d’une procédure diagnostique et thérapeutique pour établir un référentiel pratique devant un œdème papillaire bilatéral

Journal Français d'Ophtalmologie, 2008

Introduction L’hypertension intracrânienne idiopathique (HICi) est une pathologie rare, dont le d... more Introduction L’hypertension intracrânienne idiopathique (HICi) est une pathologie rare, dont le diagnostic repose sur la presence d’un œdeme papillaire, d’une imagerie neuroradiologique normale, une pression intracrânienne (PIC) elevee avec un LCR normal. Nous avons defini des criteres diagnostiques et une strategie therapeutique pour tout patient presentant des signes evocateurs d’HICi et avons evalue la faisabilite de ce protocole ainsi que l’evolution de la fonction visuelle. Objectifs et Methodes Devant un œdeme papillaire bilateral sans cause intra-oculaire ou ischemique, la demarche diagnostique etait : examen ophtalmologique, champ visuel, Lancaster, angio-scanner et/ou IRM, angiographie fluoresceinique, mesure de la PIC avec analyse biologique du LCR. Le diagnostic d’HICi pose, la demarche therapeutique reposait sur la severite de l’atteinte fonctionnelle sur au moins 1 œil. De 7 a 10/10, acetazolamide per os et controle a J15. Pour les autres patients, bolus de corticoides et acetazolamide sur 3 a 5 jours (Liu et Glaser) ; l’absence d’amelioration fonctionnelle significative conduisait a discuter l’ouverture chirurgicale des meninges peri-optiques. Chez les patients ameliores sur au moins 1 œil, l’acetazolamide seul etait poursuivi. Resultats Notre travail a porte sur 34 dossiers. La mise en evidence de paresies infra-cliniques du VI, l’existence d’une selle turcique vide, sont des anomalies souvent observees et renforcant la presomption diagnostique d’HICi. Tous les patients ont ete traites par acetazolamide. Moins de 20 % ont necessite des bolus de corticoides. Moins de 5 % ont ete traites chirurgicalement. L’amelioration ou la stabilisation de la fonction visuelle ont ete obtenues pour plus de 80 % des patients a 6 mois du diagnostic. Discussion Le diagnostic repose sur un faisceau d’arguments cliniques, radiologiques et sur la PIC ; chaque etape est contributive au diagnostic d’HICi. La multidisciplinarite de la prise en charge diagnostique de l’HICi dans un contexte d’urgence impose un referentiel codifie pour instaurer rapidement le traitement le mieux adapte a la severite de la neuropathie optique. Conclusion L’HICi demeure un diagnostic d’elimination qui requiert une procedure diagnostique associant ophtalmologiste, radiologue, neurologue. La rapidite de la strategie diagnostique et therapeutique permet d’ameliorer ou de stabiliser la grande majorite des patients.

Research paper thumbnail of 602 Évaluation de la prise en charge thérapeutique des uvéites liées à l’antigène HLA B27 : étude rétrospective sur 94 patients

Journal Français d'Ophtalmologie, 2008

1S186 délétère après boli. Après étude statistique, aucune réaction inflammatoire ni facteur de r... more 1S186 délétère après boli. Après étude statistique, aucune réaction inflammatoire ni facteur de risque, en particulier dans le groupe C, n'étaient significatifs. Discussion : Plusieurs protocoles ont été proposés dans les cataractes post-uvéitiques. Le boli par MPS est disponible, rapide et efficace. Conclusion : Le boli péri-opératoire de MPS a permis pour les yeux uvéitiques opérés de cataracte, une maîtrise de l'inflammation. Des études plus larges randomisées permettraient de confirmer ces résultats, et mieux définir les groupes « à haut risque » dans la chirurgie des yeux uvéitiques. 602 Évaluation de la prise en charge thérapeutique des uvéites liées à l'antigène HLA B27 : étude rétrospective sur 94 patients. Treatment in HLA B27 uveitis: retrospective study of 94 patients.

Research paper thumbnail of 280 À propos de deux cas de TINU syndrome

Journal Français d'Ophtalmologie, 2007

Introduction Le TINU syndrome (Tubulo Interstitial Nephritis and Uveitis syndrome) est une etiolo... more Introduction Le TINU syndrome (Tubulo Interstitial Nephritis and Uveitis syndrome) est une etiologie rare d’uveite, classiquement anterieure et bilaterale, dont la gravite potentielle impose un diagnostic precoce afin de ne pas retarder la mise en route du traitement general adapte. L’atteinte du segment posterieur, plus rarement decrite, apparait cependant comme un element de gravite supplementaire a connaitre. Objectifs et Methodes Nous presentons deux cas de TINU syndrome diagnostiques lors d’une poussee d’uveite aigue. Un adolescent de 16 ans et une femme de 39 ans caucasiens ont presente une uveite anterieure aigue bilaterale respectivement 6 et 12 mois apres le debut d’une nephrite tubulo-interstitielle idiopathique, lors d’une baisse de palier a 10 mg de prednisolone. Leur presentation clinique initiale etait proche, caracterisee par une photophobie, des douleurs, une hyperhemie conjonctivale, une baisse d’acuite visuelle moderee, un tyndall cellulaire important, des synechies irido-cristalliniennes, ainsi qu’une hyalite. L’adolescent a par ailleurs developpe une papillite bilaterale des la premiere semaine. Le recours a une corticotherapie generale a 1 mg/kg/j s’est rapidement impose et l’evolution s’est etalee sur plus de 6 mois avec une relative corticodependance. Discussion Le TINU syndrome est decrit depuis 1975, touchant les adultes jeunes ou les adolescents, avec une predominance feminine. Dans les cas presentes, l’atteinte renale precedait l’uveite avec une stabilite de la fonction renale au cours de l’episode oculaire, l’acuite visuelle etait relativement conservee, l’inflammation oculaire a ete lentement controlee par la corticotherapie. L’atteinte posterieure, plus inhabituelle reste un facteur pronostique a rechercher systematiquement. Conclusion Le ionogramme sanguin et la bandelette urinaire font partie integrante du bilan d’uveite. De meme, a l’occasion d’une nephrite tubulo-interstitielle idiopathique, l’ophtalmologiste permet de classer cette derniere en TINU Syndrome. Bien que rare, il faut savoir reconnaitre ce syndrome rapidement car il peut necessiter une corticotherapie soutenue, meme si l’atteinte renale est en remission. De plus, tous les segments oculaires peuvent etre touches. Le TINU syndrome illustre parfaitement la necessite d’une approche multidisciplinaire dans la prise en charge des uveites.

Research paper thumbnail of 292 Optimisation de la prise en charge des uvéites par une approche bidisciplinaire : pourquoi ? Comment ?

Journal Français d'Ophtalmologie, 2005