Longitudinal anatomical response of retinal-choroidal anastomosis to anti-vascular endothelial growth factor therapy.

PURPOSE: To evaluate the longitudinal anatomical response of retinal-choroidal anastomosis (RCA) to intravitreal ranibizumab injection using spectral-domain optical coherence tomography (SD-OCT). METHODS: We reviewed the medical records of 21 consecutive patients with RCA who underwent intravitreal ranibizumab injections at the University Eye Clinic of Creteil between January 2009 and June 2010. The SD-OCT features at baseline, at 3 months, and at 12 months were retrospectively analyzed. Based on SD-OCT, RCAs were classified as showing a focal retinal pigment epithelium (RPE) erosion ("erosion sign") over a small, localized RPE elevation; a focal RPE break leaving two free RPE flaps ("flap sign") at the level of a small, localized RPE elevation; or a large convex RPE prominence and a focal funnel-shaped RPE kissing an inverted focal funnel-shaped inner neuroepithelium ("kissing sign"). RESULTS: Twenty-one eyes of 21 patients (3 men and 18 women, aged 81.6 ± 6.8 years) diagnosed with RCA naive to any treatment were included for analysis. Spearman ρ correlation between best-corrected visual acuity and lesion classification was 0.54 (P = 0.01) at Month 3 and 0.85 (P < 0.001) at Month 12. Eyes showing the flap sign at baseline underwent significantly less ranibizumab injections after the loading phase (2.14 ± 0.89 vs. 3.40 ± 0.96, P = 0.007) and showed a greater improvement in best-corrected visual acuity at Month 12 (from 0.52 ± 0.14 to 0.38 ± 0.15, P = 0.03) compared with eyes showing the kissing sign. At 12 months, 3 of 10 eyes with flap sign at baseline showed RCA activity, whereas 7 of 10 regressed to erosion sign phase. Of the 10 eyes with kissing sign at baseline, 6 progressed to a fibroglial scar. CONCLUSION: A flap sign of RCA at baseline seems a favorable prognostic factor as concerns best-corrected visual acuity improvement and the need for retreatment.

HAIR DYE-INDUCED RETINOPATHY MIMICKING MEK-INHIBITOR RETINOPATHY.

PURPOSE: To report a new toxic retinopathy related to the use of hair dye. METHODS: Case reports of three patients with follow-up after exposure and until resolution. RESULTS: There were three middle-aged women (32-66 year old) all of whom had bilateral moderate to severe vision loss and normal slit-lamp examination at presentation. Fundus examination showed bilateral multiple serous retinal detachments predominantly located in the posterior pole, with some pigment epithelial hypertrophy in chronic cases. Optical coherence tomography showed similar features as in MEK-inhibitor retinopathy. Electrooculogram performed in one patient showed abnormal Arden ratio. During follow-up, visual acuity improved with regression of the serous retinal detachments. The speed of resolution was proportional to the acuteness of the exposure to aromatic amines. CONCLUSION: Hair dyes containing aromatic amines can be responsible for bilateral toxic retinopathy mimicking MEK-inhibitor retinopathy.

Effectiveness and safety of dexamethasone implants for postsurgical macular oedema including Irvine-Gass syndrome: the EPISODIC-2 study.

AIM: To assess the effectiveness of intravitreal dexamethasone implants for treating postsurgical macular oedema (PSMO) including Irvine-Gass syndrome and determining the predictive factors of treatment response. METHODS: Descriptive, observational, retrospective, consecutive, uncontrolled, multicentre, national case series. One hundred patients were included between April 2011 and June 2014, with a minimum of 1-year follow-up. Patients received dexamethasone implant 0.7 mg at baseline. Clinical characteristics, best-corrected visual acuity (BCVA), central subfield macular thickness (CSMT) and intraocular pressure were measured at each visit. The main outcome measure was the change in BCVA (Early Treatment of Diabetic Retinopathy Study (ETDRS) letters: L). An analysis of predictive factors of treatment response is also provided. RESULTS: Mean improvement in BCVA was 9.6 (±10.6) L at month 6 and 10.3 (±10.7) L at month 12 (p<0.001). The proportion of eyes with gains in BCVA of 15 or more letters was 32.5% and 37.5% at months 6 and 12, respectively. The mean reduction in CSMT was 135.2 and 160.9 µm at months 6 and 12, respectively (p<0.001). Thirty-seven per cent of patients did not need a second injection after the first injection during follow-up. The presence of at least one PSMO risk factor decreases the probability of a gain in visual acuity (VA) ≥10 L (p=0.006). Initial VA ≤50 L at baseline and non-naïve status decrease the probability of having only one injection during follow-up (p=0.044). CONCLUSIONS: The significant gain in BCVA from baseline achieved at month 6 was maintained at month 12 after intravitreal injection of dexamethasone implant. Naïve status seems to be a good predictive factor of treatment response.

Retinal arterial macroaneurysms: clinical, angiographic, and tomographic description and therapeutic management of a series of 14 cases.

PURPOSE: To describe clinical, angiographic, and tomographic features and the therapeutic management of patients with retinal arterial macroaneurysm (RAM). METHODS: Retrospective analysis of patients diagnosed with RAM between January 2011 and September 2014 in Professor Sahel's Department of Ophthalmology, Rothschild Foundation. Retinal arterial macroaneurysms were classified as hemorrhagic, exudative, or quiescent. Patient demographics and comorbidities were recorded. All patients underwent complete ophthalmologic examination including initial and final visual acuity (Early Treatment Diabetic Retinopathy Study chart), slit-lamp biomicroscopy, fundus examination, color and autofluorescence fundus imaging, fluorescein and indocyanine green angiography, and spectral-domain optical coherence tomography. Treatments were recorded. RESULTS: Fourteen RAMs of 14 patients were included: 9 hemorrhagic and 5 exudative. The most severe clinical picture was associated with the hemorrhagic form. Exudative cases had a progressive onset and a better visual prognosis. Direct laser photocoagulation was performed in 4 cases, anti-vascular endothelial growth factor (VEGF) intravitreal injection in 4 cases, combined treatment (YAG laser + argon laser + anti-VEGF intravitreal injection) in 1 case, and 5 cases received no treatment. CONCLUSIONS: Retinal arterial macroaneurysm management should be specialized and rapid. Multimodal imaging should be performed for classifying it, assessing its prognosis and determining the most suitable treatment.

B-scan and "en-face" spectral-domain optical coherence tomography imaging for the diagnosis and followup of acute retinal pigment epitheliitis.

Purpose. To report B-scan and "En-face" spectral-domain optical coherence tomography (SD-OCT) findings in acute retinal pigment epitheliitis (ARPE). Methods. Two patients (3 eyes) with ARPE were examined. Fluorescein and indocyanine green (ICGA) angiography, B-scan, and "En-face" SD-OCT were performed in each patient at initial and follow-up visits. Results. Both patients presented with acute onset of blurred vision, and one with bilateral involvement. B-can OCT revealed disruption of the macular retinal pigment epithelial (RPE) inner band layer and photoreceptors' inner and outer segment (IS-OS) junction. Hyperreflective dots were observed in the outer nuclear layer (ONL) above the RPE/IS-OS disruption. Just around these hyperreflective dots, slight thickening of the hyperreflective IS/OS junction was observed. During the late phase, indocyanine green angiography (ICGA) showed a macular cockade-like hyperfluorescent halo. "En-face" OCT showed the same cockade-like appearance with a hyporeflective center and a hyperreflective border matching the pattern observed on ICGA. At followup, as vision improved without treatment, B-scan OCT demonstrated progressive resolution of the hyperreflective and disrupted lesions; "en-face" OCT also showed disappearance of the macular cockade-like halo with a transient discrete hyperreflective macular star at the RPE level in one eye. Conclusion. "En-face" OCT associated with B-scan SD-OCT analysis appears to be very helpful in the diagnosis and followup of ARPE. The pathophysiology of ARPE remains complex and still poorly understood. These techniques help define the location and extent of structural damage occurring in this disease.