Smoking and short-term response to intravitreal anti-Vascular Endothelial Growth Factor injections in neovascular age-related macular degeneration.

PURPOSE: To evaluate the role of smoking status on the response to three monthly intravitreal anti-Vascular Endothelial Growth Factor (anti-VEGF) injections in treatment-naive neovascular AMD (nAMD) patients. METHODS: We conducted a single-center, retrospective, case-control cohort study in Belgium. RESULTS: Intravitreal treatment (IVT) was performed in 147 eyes of 131 patients, including 92 females (70%). Mean age at the time of the first IVT was 79±9 years. Seventeen patients (13%) were actively smoking at the time of the anti-VEGF IVT. On average, active smokers were 11 years younger than non-smokers when starting IVT treatment. They also showed more frequent subretinal fluid than non-smokers (94% vs. 65%). Mann-Whitney analyses comparing change in central macular thickness and change in logarithm of the minimum angle of resolution visual acuity between active smokers and non-smokers showed no significant difference in treatment response between both groups. Likewise, no significant difference was found when comparing treatment response between patients with less than 10 pack-years (PY) (including never-smokers) and patients with over 10 PY. In a binary logistic regression model, male patients responded worse to anti-VEGF IVT than their female counterparts, with an odds ratio (OR) of 0.27 for good response. This was the only statistically significant predictor of treatment response. CONCLUSION: Our study failed to demonstrate an effect of smoking on the short-term treatment response to anti-VEGF in nAMD.

Clinical Utility of 18F-FDG PET/CT in the Work-up of Children with Uveitis.

PURPOSE: To evaluate 18F-fluorodeoxyglucose Positron Emission Tomography/ultra low dose Computed Tomography (18F-FDG PET/ ULD CT) in the work-up of pediatric uveitis. METHODS: Retrospective study of 12 children followed for uveitis who underwent whole body 18F-FDG PET/ULD CT between 2011 and 2019. RESULTS: The average age of the patients was 11 years. A total of 100% of patients presented with bilateral uveitis, 50% had panuveitis and 92% had various choroidal involvement. Relevant information for diagnosis was provided in four patients. 5/12 had an abnormal 18F-FDG uptake. Of these, three patients had pathognomonic images of active granulomatous diseases. Three patients underwent PET CT-guided biopsies of which two were positive for sarcoidosis. CONCLUSION: 18F-FDG PET/CT provided important information for final diagnosis in approximately 30% (4/12) of pediatric patients with bilateral uveitis. Whole body FDG PET/ULD CT can contribute to the final diagnosis thanks to pathognomonic image of active granulomatous disease and/or by indicating metabolically active site of biopsy that would not be visualized in thorax CT.

[Value of systematic screening for depressive symptoms and Charles-Bonnet syndrome in AMD patients]. / Intérêt du dépistage systématique des affects dépressifs et du syndrome de Charles­Bonnet chez les patients atteints de DMLA.

INTRODUCTION: Age-related macular degeneration (ARMD) is the leading cause of blindness in western countries. Along with decrease in vision, ARMD patients, who are often elderly, carry an increased risk of developing depression and Charles-Bonnet syndrome (CBS). However, these disorders remain under-diagnosed. Detection and treatment could considerably improve their quality of life. The aim of our study is to evaluate the relevance and feasibility of systematic screening for depression and CBS in AMD patients. MATERIALS AND METHOD: Patients with ARMD, who showed up to the ophthalmology department of CHU Brugmann (Brussels, Belgium, Université Libre de Bruxelles) over a 4-week period, were asked to measure their depression score using the Geriatric Depression Scale (GDS-15) and to complete a questionnaire on CBS. RESULTS: In total, 112 patients were recruited. One hundred and six responded to the GDS-15 score; among them 70 patients (66.04%) suffered from depressive symptoms. A multivariate analysis highlighted three risk factors: decreased vision in the better eye (P=0.023), unilateral impairment (P=0.024) and social isolation (P<0.001). One hundred and twelve patients completed the CBS questionnaire, no new diagnoses were made. Six of the 112 patients (5.7%) knew about CBS. CONCLUSION: Screening through the GDS-15 depression score should be performed systematically in all ARMD patients. It is important not to overlook psychosocial factors in those patients. In our study, more than two thirds of patients suffer from unrecognised depressive affects. Early detection and adequate treatment could significantly improve their quality of life and compliance. As far as CBS is concerned, given its low prevalence, objective criteria should be established in order to select the patients who need screening.

Peculiar presentation of bilateral choroidal osteoma in a child.

Report of a presentation of bilateral choroidal osteoma without neovascularization in a child following a school screening. Diagnosis was based on funduscopy, optical coherence tomography and B-scan ultrasonography. The child was followed regularly with cycloplegic refraction, funduscopy, macular SD-OCT and EDI-SD-OCT. Fluorescein angiography and OCT-angiography will be performed if necessary. PURPOSE: To report a peculiar presentation of bilateral choroidal osteoma in a very young child. METHODS: Case report. RESULTS: During a school screening, a 4-year-old girl was detected with anisometropia as the first sign of a bilateral choroidal osteoma. The diagnosis was based on funduscopy, optical coherence tomography and B-scan ultrasonography. CONCLUSION: Choroidal osteomas are rare benign tumors that can lead to severe visual loss due to progression or complications. They are found mostly in young adults, but in our case, the refractive screening allowed an early diagnosis despite the lack of visual symptoms.

Long-term results of low-fluence photodynamic therapy for chronic central serous chorioretinopathy.

PURPOSE: To evaluate long-term results of low-fluence photodynamic therapy (PDT) with verteporfin in the treatment of chronic central serous chorioretinopathy (CCSC). METHODS: Retrospective medical record review of 38 eyes (34 patients) who received low-fluence PDT for the treatment of CCSC. Visual acuity (VA), fundus biomicroscopy, fluorescein angiography (FA), indocyanine green angiography (ICG) and optical coherence tomography (OCT) were analyzed. RESULTS: Thirty-eight eyes (34 patients) with CCSC received low-fluence PDT. Mean follow-up after PDT was 43.97 months. Mean logMar best corrected VA (BCVA) improved significantly from 0.33 to 0.11 at the last follow-up which corresponds to a gain of 2.2 lines. At 3 months, complete resolution of central subretinal fluid was achieved on OCT after 1 PDT in 37 eyes and after 2 PDTs in 1 eye (retreated at 3 months after first PDT). One patient developed choroidal neovascularization (CNV) 4 years after his low-fluence PDT and received anti-vascular endothelial growth factor (VEGF) injections. CONCLUSION: Low-fluence PDT with verteporfin for CCSC seems efficacious and safe in the long-term.

Successful photodynamic therapy combined with laser photocoagulation in three eyes with classic subfoveal choroidal neovascularisation affecting two patients with multifocal choroiditis: case reports.

Multifocal choroiditis (MC) is an idiopathic choroidal inflammatory disease affecting young subjects. Secondary choroidal--and often central--neovascularisation is a frequent complication leading to a poor visual prognosis. Photodynamic therapy (PDT) has now proven to be successful to treat classic subfoveal choroidal neovascularisation in age-related macular degeneration and in pathologic myopia. We describe the treatment applied to classic choroidal neovascularisation in two young women with MC, two eyes with subfoveal neovascular membrane and one eye in which new vessels encroach the foveal avascular zone. PDT has been useful in the three reported eyes, with stable or improved visual acuity. In two of them, it even made the membrane retract and become extrafoveal, allowing a secondary treatment using conventional laser.

[Ocular Behcet's disease: procedural aspects]. / Behçet oculaire: aspects pratiques.

The diagnosis of ocular Behçet is clinical. This affection is characterised by a bilateral anterior and/or posterior recurrent non granulomatous intraocular inflammation. The treatment consists in the use of one or several associated immunomodulators and immunosuppressors. In order to decrease the drug toxicity we prefer to increase the number of associated drugs than to increase the doses in severe resistant cases. The prognosis can be significantly improved by a very strict control of chronic inflammation and of each exacerbation. Interferon alpha could be a good new treatment in the future.

Discontinuation of maintenance therapy for CMV retinitis in AIDS patients on highly active antiretroviral therapy.

The use of highly active antiretroviral therapy (HAART) has dramatically modified the natural history of cytomegalovirus retinitis (CMVR) in AIDS patients. In this context, we discontinued maintenance therapy in eight AIDS patients with previous CMVR and a good and persistent immune and virological response to HAART (CD(4) >/= 75/mm(3) in all patients, viral load

Neovascularization of the optic disc after highly active antiretroviral therapy in an AIDS patient with cytomegalovirus retinitis--A new immune recovery-related ocular disorder?

A patient with AIDS and cytomegalovirus (CMV) retinitis developed a massive bilateral peripheral occlusive vasculopathy with a bilateral neovascularization of the optic disc five weeks after the introduction of highly active antiretroviral therapy (HAART). No associate cause of occlusive vasculopathy was found. Occlusive vasculopathy and optic disc neovascularization may be an immune recovery-related ocular disorder.

Late side-effects of radiotherapy for subfoveal choroidal neovascularization.

Radiation therapy for subfoveal neovascularization has not yet proved its efficiency, but, to our knowledge, no exudative complication of this treatment has been reported. We describe a late side effect observed in 16 eyes after a mean follow up of 33 months, characterized by major extension and exudation of the choroidal new vessels. In several cases, development of elongated, club like new vessels was observed at the border of the neovascular membrane. At the end of the follow-up, 4 eyes had an exudative retinal detachment affecting half of the retina or more and visual acuity was < or = 1/50 in 94% of the cases (including a case with no light perception and 2 cases with only light perception).

Subfoveal choroidal neovascularization: radiotherapy or perifoveal photocoagulation? A fellow eye study.

Perifoveolar photocoagulation is advised for subfoveal choroidal neovascularization responding to the MPS eligibility criteria. Recently, radiation therapy has been proposed but has not yet proved its efficacy. We compared these two treatments. We retrospectively reviewed 27 patients with age related macular degeneration and subfoveal choroidal neovascularization in both eyes. The first eye was treated with perifoveolar photocoagulation and the second eye with radiotherapy. In case of simultaneous diagnosis, radiotherapy was performed in the eye with the best visual acuity. Although the follow up is two times longer and the initial visual acuity is lower in the group of the photocoagulated eyes, both groups have similar results at the end of their respective follow up. However, in the eyes treated with radiotherapy the lesions are still active and edematous while in the eyes treated with perifoveolar photocoagulation, the lesions are stable and dry. The percentage of patients who subjectively prefer the photocoagulated eye has increased progressively from 0% to 71.5% along the 20 months of follow-up post radiotherapy. The perifoveolar photocoagulation of the subfoveal choroidal neovascularization seems, at median term, to give better objective and subjective results than the radiation therapy.

[Laser treatment of detachments of the retinal pigment epithelium associated with sub-retinal neovascularization in the context of age-related macular degeneration: retrospective study]. / Traitement au laser des décollements de l'épithélium pigmentaire rétinien associes à des néovaisseaux sous-rétiniens dans le cadre de la degenerescence maculaire liée à l'âgè: étude rétrospective.

Pigment Epithelial Detachment (PED) associated with subretinal new vessels (SRNV) is a particular aspect of Age Related Macular Degeneration (ARMD). We retrospectively analysed the results of dye laser photocoagulation in 63 eyes of 56 patients with vascularised PED. We photocoagulated in a confluent manner the presumed zones of SRNV, detected by fluorescein angiography and three-mirrors-lens examination. In most cases, the SRNV were of the occult type. In 89% of the treated eyes we obtained a flattening of the PED and the visual acuity was stabilized or ameliorated in 66% of the cases after a mean follow up of 29 months. This final visual acuity was better or equal to 1/10 in 64% of the cases and superior or equal to 5/10 in 46% of the cases. Subfoveal SRNV, initial visual acuity of less than 1/10, and persistence or recurrence of the PED after treatment were of bad prognosis. However, recurrence of the SRNV was not necessarily of bad prognosis if it could be retreated. Treatment of interpapillomacular SRNV had the best prognosis. Laser photocoagulation can be beneficial in well selected patients with vascularised PED.

[Impact of anti-retroviral treatment with protease inhibitors on the evolution of cytomegalovirus retinitis in the patient carrying acquired immunodeficiency syndrome]. / Impact du traitement anti-rétroviral par inhibiteurs des protéases sur l'évolution de la rétinite à cytomégalovirus chez le patient porteur du syndrome d'immunodéficience acquise.

Up to now cytomegalovirus retinitis (CMVR) recurrence in AIDS patients was considered to be very high, even on maintenance therapy. Protease inhibitors (PI) are antiretroviral molecules which, with more efficacity than reverse transcriptase inhibitors, decrease viral charge and increase CD4's count aswell as survival. We analysed the impact of PI on CMVR evolution in a retrospective review of 18 patients with CMVR on maintenance therapy and PI treatment. In a first group, 13 patients started PI some time after CMVR diagnosis (median CD4 = 9/mm3). A second group of 5 patients developed CMVR (median CD4 = 63/mm3) after initiation of PI. In the first group, incidence of CMVR recurrences/1000 patients days was 6,45 (2323 patients days of follow-up (PDFU) before starting PI and 3,44 (4066 PDFU) after starting PI. In this group, during the follow-up's period of CD4's count inferior to 75/mm3, incidence of CMVR is 6,84/1000 patients days and becomes 0,86/1000 patients days during the follow-up's period of CD4's count superior to 75/mm3. In the second group, incidence of CMVR was 0/1000 patients days (1972 PDFU). In summary, incidence of CMVR decreases with PI's treatment. Interruption of CMVR maintenance therapy could be considered in patients with CD4's count higher than 75/mm3.