Ischemic optic neuropathies (IONs) are among the most prevalent diseases causing visual impairment in middle-aged and elderly people. While arteritic ION is an ocular emergency and requires early diagnosis and immediate treatment with systemic high-dose corticosteroids to prevent further visual loss, treatment options for non-arteritic ION remain limited. We describe the case of a woman with unilateral right-sided non-arteritic posterior ischemic optic neuropathy. The diagnosis was made on clinical and radiographic grounds. Diffusion-weighted sequences and apparent diffusion coefficient maps revealed markedly restricted diffusion in the right optic nerve. It was very helpful to precise the posterior topography of the optic nerve lesion. Furthermore, we reported the diffusion tensor tractography study which appears to be an objective tool to assess the incomplete visual recovery. These MRI techniques including tensor tractography remain to be evaluated in large cohort of ION patients' particularly in future therapeutic trials.

Hereditary Haemorrhagic Telangiectasia (HHT) is a genetic disorder responsible for cutaneous or mucosal telangiectasia and arteriovenous malformations (AVMs). The most frequent locations are lung and brain. In contrast, orbital AVMs are very rare. We describe a case of symptomatic orbital arteriovenous malformation due to spontaneous thrombosis. A 65-year-old woman was referred for chronic right eye proptosis associated with dilation of conjunctival vessels with a jellyfish pattern. Right visual acuity was 20/40 and intraocular pressure was 40 mmHg. Personal and familial history of recurrent epistaxis, associated with multiple telangiectasia within lips and palate, led to the diagnosis of HHT. Magnetic resonance imaging (MRI) completed with cerebral angiography found a giant and occluded AVM within the right orbit. Other AVMs were also found in brain and chest, confirming the diagnosis. Antiglaucomatous eyedrops were added to reduce intraocular pressure and a steroid therapy was begun. Two months later, visual acuity decreased in the right eye, due to a central retinal vein thrombosis. In conclusion, Most brain or pulmonary AVM can be treated by embolization. By contrast, this treatment in case of orbital location can lead to central retinal artery and/or central retinal vein occlusion, which may also appear as a spontaneous complication of the orbital AVM. Therapeutic management of orbital AVM is thus not standardized, and the balance between spontaneous and iatrogenic risk of visual loss has to be taken into account.

Iatrogeny is a paradoxical domain from several points of view: it is a daily preoccupation for physicians but scientific data on its frequency and consequences are rare. The best way to reduce iatrogenic results is prevention but clearly identified preventive methods and their evaluation for efficacy are also scarce. Finally, patients dread it, but they are often the first to demand new technologies, even if evaluation is incomplete. Indeed, iatrogenic results peak when new therapeutics or diagnostic procedures first appear on the market, because a large number of patients is needed to evaluate the risk involved. A posteriori evaluation of emerging medical or diagnostic procedures, i.e., after several months of marketing, thus remains the best guarantee for improving the quality of care.

INTRODUCTION: To report two patients with primary pulmonary hypertension (PPH) and associated ocular findings. CASE REPORT: Two men, 54 and 50 years old, were referred for primary pulmonary hypertension: one patient had had a double-lung transplantation a month before and noticed pain and decreased vision in the right eye; the other man was waiting for a lung transplant and noticed decreased vision in the left eye. Both patients presented with a dilatation of the conjunctival and episcleral veins, without glaucoma, and with bilateral chronic choroidal ischemia. One patient underwent a fluorescein angiography examination and indocyanine green videoangiography. CONCLUSION: Elevated venous pressure is responsible for the dilatation of the conjunctival and episcleral veins, sometimes associated with glaucoma, and for chronic choroidal ischemia with a decrease in visual acuity. Other clinical pictures are discussed.

We report a case of adenomatous hyperplasia of the conjunctiva. A 42-year-old man was referred for a left conjunctival lesion involving the caruncle; the histopathological patterns revealed benign adenomatous hyperplasia, a disease that may originate in the conjunctiva. Adenomatous hyperplasia of the conjunctiva is a benign condition. The absence of cytonuclear anomalies and mitotic activity distinguishes adenomatous hyperplasia from adenocarcinoma and mucoepidermoid carcinoma.

We report a case report of extensive eyelid necrosis caused by an insect bite. A 39-year-old man had suffered ocular trauma from a hymenopteran insect in Tunisia. The patient presented with eyelid necrosis. Eyelid necrosis mechanisms following insect bites are discussed and other causes of eyelid necrosis are presented. Eyelid necrosis, often caused by vasoconstrictive medications or animal venoms, notably hymenopteran insect bites, can result in substantial eyelid injury.

Fluoroquinolones are commonly used in ophthalmology, either for conjunctival infections or endophthalmitis. Use of these antibiotics requires good knowledge of the pharmacokinetic profile and adverse effects, and contraindications must be respected. Fluoroquinolones are useful in 2008 given their antibacterial spectrum, good ocular penetration, and the potential benefit of intravitreal injection.

The arrival of fluoroquinolones in the 1980s aroused enormous enthusiasm in the medical community, justified by the spectrum of antibacterial activity, good tolerance, and wide distribution in tissues, even after oral administration. However, the extensive use of these new antibiotiques finally ended in emerging resistance, which limits the efficiency of all the molecules in the class, including those that have appeared in the last few years. Ocular diseases also benefited from the emergence of fluoroquinolones, notably for topical treatments. It is now mandatory to adapt the prescriptions to the best indications, in order to protect the vast therapeutic potential of these molecules.

Purtscher's retinopathy is a rare condition, seen in patients with a history of trauma. Purtscher-like retinopathy includes the nontraumatic causes of this retinal disease, which is often misdiagnosed. The diagnosis is based on clinical settings and is supported by intravenous fluorescein angiography. We describe a case of acute, severe retinopathy in a patient experiencing a scleroderma renal crisis. We discuss the pathogeny, prognosis and treatment, which is still widely controversial.

The journal impact factor, calculated annually by Thomson Scientific (Connecticut, USA), is widely used for many functions including the process of academic evaluation. This article reviews the current trend of the impact factor of journals dedicated to ophthalmology. Journals publishing a larger volume of articles on a broad range of topics, such as Archives of Ophthalmology, American Journal of Ophthalmology, and Ophthalmology, rank at the top in this aspect, and the majority of journals from the Europe and Japan have a lower impact factor. It is desirable to keep in mind inherent drawbacks of the journal impact factor and to use it wisely when assessing a person for tenure or grant.

OBJECTIVES The research sought to determine the publication types cited most often in public health as well as the most heavily cited journal titles. METHODS From a pool of 33,449 citations in 934 articles published in the 2003-2005 issues of American Journal of Public Health, 2 random samples were drawn: one (n = 1,034) from the total set of citations and one (n = 1,016) from the citations to journal articles. For each sampled citation, investigators noted publication type, publication date, uniform resource locator (URL) citation (yes/no), and, for the journal article sample, journal titles. The cited journal titles were analyzed using Bradford zones. RESULTS The majority of cited items from the overall sample of 1,034 items were journal articles (64.4%, n = 666), followed by government documents (n = 130), books (n = 122), and miscellaneous sources (n = 116). Publication date ranged from 1826-2005 (mean = 1995, mode = 2002). Most cited items were between 0 and 5 years old (50.3%, n = 512). In the sample of 1,016 journal article citations, a total of 387 journal titles were cited. DISCUSSION Analysis of cited material types revealed results similar to citation analyses in specific public health disciplines, including use of materials from a wide range of disciplines, reliance on miscellaneous and government documents, and need for older publications.

BACKGROUND: Our aim, as part of the collaborative study SPHERE (Strengthening Public Health Research in Europe), was to describe public health publications in the French language according to health needs and public health functions. METHOD: All articles published in six French public health journals, and one French/English language Canadian journal, over the period 1995-2004, were retrieved from three electronic databases. Original research articles were indexed by hand according to one main domain of health need, based on Global Burden of Disease categories, and into one of four public health functions. RESULTS: After removing duplicates, 3984 original research articles were identified. Only 51% could be allocated to a health needs code. Of these, 71% were about non-communicable diseases, 25% communicable, maternal and perinatal conditions and 5% injuries. This compared only moderately with the global burden of disease for France (84, 5 and 11%, respectively). The other articles addressed health determinants, such as behavioural or environmental exposures, or a methodological issue. Ninety-two percent of the articles could be assigned a public health function code. Health monitoring and health services research accounted for 80% of references from French journals. Only 9% of articles from French journals were related to prevention, which was lower than that in the Canadian journal (17%). Only 1% of articles dealt with legislation. CONCLUSION: The distribution of articles in French public health journals broadly follows the distribution of health needs. History and data availability may explain the extra research focus on communicable diseases and maternal and child health research. Injuries, and prevention, are topics which appear to be under-represented in French language journals.

PURPOSE To investigate the outcome of manuscripts submitted to the American Journal of Ophthalmology (AJO) between July 23, 2002 and December 31, 2003. DESIGN Observational series. METHODS Data were collected on all Full-Length Articles and Brief Reports submitted to the AJO. Data were recorded for rejected or withdrawn manuscripts about the date of submission and decision, category of decision, type of article, manuscript region of origin, alternate journal of manuscript, date of publication, and impact factor and immediacy index of the subsequent journal. Corresponding data were collected from the manuscripts accepted over the same period. The Advanced PubMed online database was searched to determine if the rejected or withdrawn manuscripts were published elsewhere. The impact factor and the immediacy index of the journal of the subsequent journal was then recorded and compared with those of the AJO, using the year 2004 for comparison. RESULTS Of 2,026 manuscripts submitted, 1,444 were rejected by the AJO or withdrawn by the authors and 50% of these were subsequently published elsewhere in a PubMed listed journal. The rejected or withdrawn articles were typically published in lower impact journals, most commonly in general ophthalmology journals in the author's region or in subspecialty journals, although several were published in higher impact journals. The 727 articles were published in 94 different journals and usually with an extended delay. CONCLUSIONS Rejection of a manuscript by the AJO does not preclude publication, but rejected manuscripts are published more often in journals that serve a smaller readership and are cited less frequently, although exceptions exist.