Influence of new societal factors on neovascular age-related macular degeneration outcomes.

BACKGROUND: To assess the impact of unstudied societal factors for neovascular age-related macular degeneration (nAMD) on functional outcomes after anti-VEGFs. METHODS: Charts of 94 nAMD patients treated in the Monticelli-Paradis Centre, Marseille, France, were reviewed. Phone interviews were conducted to assess societal factors, including transportation, living status, daily reading and social security scheme (SSS). Primary outcome was the impact of family support and disease burden on functional improvement in nAMD. RESULTS: Between baseline and month 24 (M24), 42.4% of the variability in best-corrected visual acuity (BCVA) was explained by the cumulative effect of the following societal factors: intermittent out-patient follow-up, marital status, daily reading, transportation type, commuting time. No isolated societal factor significantly correlated with ETDRS BCVA severity at M24. A trend to correlation was observed between the EDTRS score at M24 and the SSS (P = 0.076), economic burden (P = 0.075), time between diagnosis and treatment initiation (P = 0.070). A significant correlation was found for the disease burdensome on the patient (P = 0.034) and low vision rehabilitation (P = 0.014). CONCLUSIONS: Societal factors could influence functional outcomes in nAMD patients treated with anti-VEGFs. They could contribute to the healing process or sustain disease progression.

Ten years follow-up after surgery for a foveal detachment due to optic disc pit: a case report of outer retinal layer healing.

BACKGROUND: To report a case of complete progressive visual recovery and healing of outer retinal layers after vitrectomy for foveal detachment associated with optic disc pit. CASE PRESENTATION: Optical coherence tomography (OCT) follow-up was performed on a 15-year-old boy with deep optic disc pit and foveal detachment, before and for 10 years after vitrectomy with gas. The foveal detachment was successfully reattached with complete reapplication of the retina. OCT scans showed a progressive long-term retinal healing with reappearance of the ellipsoid line and visual acuity improved from 20/100 before surgery to 20/25, 10 years after surgery. CONCLUSIONS: Photoreceptor regeneration after foveal detachment surgery has been already described only in zebrafish but never humans. However, we highlight with this case that in humans, a healing process of the outer retinal layers can occur with reappearance of the ellipsoid zone on OCT. This healing process may take several years and allow a complete functional restoration.

Prospective, Observational, Multicenter, Real-World Study of the Efficacy, Safety, and Pattern of Use of the Dexamethasone Intravitreal Implant in Diabetic Macular Edema in France: Short-Term Outcomes of LOUVRE 3.

INTRODUCTION: To evaluate real-world efficacy, safety, and treatment patterns with the dexamethasone intravitreal implant (DEX) in diabetic macular edema (DME) in France. METHODS: In this prospective, multicenter, observational, noncomparative, post-reimbursement study, consecutively enrolled patients with DME had a baseline evaluation on day 0. Those treated with DEX on day 0 were to be reevaluated at week 6 and months 6, 12, 18, and 24. DEX retreatment and/or alternative therapies were allowed during follow-up. The primary outcome measure was the maximum best corrected visual acuity (BCVA) gain from baseline during follow-up. Secondary outcome measures included time to maximum BCVA gain, patients (%) with prespecified BCVA gains from baseline at each visit, maximum central retinal thickness (CRT) reduction from baseline, patients (%) with CRT reduction ≥ 20% from baseline at each visit, patients (%) with DME resolution (per investigator judgement), and adverse events (AEs). RESULTS: Of 112 patients/eyes with DME for 3.5 years (mean) at baseline, 80 (including 86.1% previously treated) received DEX on day 0 and were analyzed for efficacy. Early study termination precluded collection of ≥ 12-month efficacy data. Patients received 1.4 DEX injections over 8.3 months (averages). The maximum BCVA gain from baseline was 3.6 letters, reached after 77.2 days (averages); 24.6% (week 6) and 15.0% (month 6) of patients experienced ≥ 10-letter BCVA gains from baseline. The mean maximum CRT reduction from baseline was -146.4 µm; 61.4% (week 6) and 36.0% (month 6) of patients had CRT reductions ≥ 20% from baseline, and 68.1% reported DME resolution at least once during follow-up. Ocular hypertension (n = 8, 12.1%) was the most frequent treatment-related AE. CONCLUSIONS: LOUVRE 3 confirmed that DEX improves BCVA and CRT, even in a patient population that had predominantly received DEX before enrollment in the study, and showed that DME resolution was observed during follow-up. DEX tolerability was consistent with published data, supporting treatment benefits in DME. GOV IDENTIFIER: NCT03003416.

Nocardia transvalensis keratitis: an emerging pathology among travelers returning from Asia.

BACKGROUND: The incidence rate of Nocardia keratitis is increasing, with new species identified thanks to molecular methods. We herein report a case of Nocardia transvalensis keratitis, illustrating this emerging pathology among travellers returning from Asia. CASE PRESENTATION: A 23-year-old man presented with a 10-week history of ocular pain, redness, and blurred vision in his right eye following a projectile foreign body impacting the cornea while motor biking in Thaïland. At presentation, a central epithelial defect with a central whitish stromal infiltrate associated with pinhead satellite infiltrates was observed. Identification with 16S rRNA PCR sequencing and microbiological culture of corneal scraping and revealed N. transvalensis as the causative organism. Treatment was initiated with intensive topical amikacin, oral ketoconazole and oral doxycycline. After a four-week treatment period, the corneal infiltrate decreased so that only a faint subepithelial opacity remained. CONCLUSION: Nocardia organisms should be suspected as the causative agent of any case of keratitis in travelers returning from Asia. With appropriate therapy, Nocardia keratitis resolves, resulting in good visual outcome.

Hemodilution therapy using automated erythrocytapheresis in central retinal vein occlusion: results of a multicenter randomized controlled study.

BACKGROUND: Central retinal vein occlusion (CRVO) leads to poor visual outcome in most eyes. Abnormal hemorheology was suspected to play a major role in its pathogenesis. CRVO treatment is still a matter of debate but several studies have pointed out the efficacy of isovolumic hemodilution. The aim of this study was to assess the feasibility and efficacy of hemodilution using automated erythrocytapheresis in recent-onset CRVO. METHODS: In this prospective randomized controlled multicenter study, 61 consecutive CRVO patients were enrolled when they met the following criteria: CRVO lasting for 3 weeks or less, visual acuity ranging from 20/200 to 20/32, age between 18 and 85 years, no diabetes, no uncontrolled systemic hypertension, no antiplatelet or anticoagulant therapy, hematocrit higher than 38%, and signed informed consent. Patients were randomly assigned to the hemodilution group (n = 31) or to the control group (n = 30). Hemodilution therapy consisted of one session of erythrocytapheresis on outpatient basis, followed by additional session(s) for 6 weeks if needed. Target hematocrit was 35%. Follow-up was 12 months. RESULTS: No statistical differences in age, associated risk factors, or CRVO characteristics were observed at baseline between both groups. Mean visual acuity was equivalent to 20/80 in the hemodilution group and to 20/63 in the control group (non-significant difference). In the treated group, mean number of hemodilution sessions was 3.3 (range, 1 to 6), and no major side-effects occurred. At the 12-month follow-up visit, 64.5% of the hemodilution group had visual acuity of 20/40 or better compared to 40% of the control group (p = .048). Visual change was a gain of 1.7 ETDRS line in the hemodilution group versus a loss of 2.3 lines in the control group (p = .007). There was less conversion into an ischemic form in the hemodilution group (11%) than in the control group (50%, p = .004). Mean final retinal thickness was 289 µm in the hemodilution group versus 401 µm in the control group (p = .068). CONCLUSIONS: This multicenter controlled randomized study demonstrated that automated erythrocytapheresis is a safe and effective tool for performing hemodilution and confirmed that hemodilution therapy can improve the final prognosis of CRVO when applied in the early phase of the disease.

The AflibeRcept use in rEal life study for the treatment of diabetiC macular oedema In the French overseas territories: A 12 months follow-up Study - The RECIF Study.

PURPOSE: The incidence and severity of diabetes is particularly high in the French overseas territories (FOT). The RECIF study evaluated real life management of diabetic macular oedema (DME) treated by aflibercept in FOT. METHODS: A prospective, noncomparative, multicentric, non-interventional, study that evaluated functional and anatomical results of patients treated by aflibercept. Twelve retina specialists working in French Polynesia, La Reunion, Guadeloupe and Martinique participated in the study. RESULTS: 67 eyes of 57 patients were followed for 12 months. Average VA gain was 7.8 ETDRS letters. 29.9% of eyes gained at least 15 letters, 6% lost 15 letters or more. 67.2% of eyes achieved visual acuity of 70 letters or better. Average central retinal thickness decrease was 115.3 µm. The mean number of injections during the 1st year of treatment was 4.9. 69% of eyes had a loading dose of at least three-monthly injections. 3 eyes were switched to steroid injections during the follow-up for lack of efficacy. CONCLUSION: This study confirmed the efficacy of intravitreal treatment of DME by aflibercept, in the French overseas territories. This evaluation of real-life management of DME underlines the importance of improvement of patient education and collaboration with referring physicians.

Visual Acuity Gain Profiles and Anatomical Prognosis Factors in Patients with Drug-Naive Diabetic Macular Edema Treated with Dexamethasone Implant: The NAVEDEX Study.

The purpose of this study is to evaluate the visual acuity (VA) gain profiles between patients with drug-naive diabetic macular edema (DME) treated by dexamethasone implant (DEX-implant) and assess the baseline anatomical and functional factors that could influence the response to the treatment in real-life conditions. A retrospective, multi-center observational study included 129 eyes with drug-naive DME treated by DEX-implant. The Median follow-up was 13 months. Two groups of VA gain trajectories were identified-Group A, with 71% (n = 96) of patients whose average VA gain was less than five letters and Group B, with 29% (n = 33) of patients with an average gain of 20 letters. The probability of belonging to Group B was significantly higher in patients with baseline VA < 37 letters (p = 0.001). Ellipsoid zone alterations (EZAs) or disorganization of retinal inner layers (DRILs) were associated with a lower final VA (53.0 letters versus 66.4, p = 0.002) but without a significant difference in VA gain (4.9 letters versus 6.8, p = 0.582). Despite a low baseline VA, this subgroup of patients tends to have greater visual gain, encouraging treatment with DEX-implant in such advanced-stage disease. However, some baseline anatomic parameters, such as the presence of EZAs or DRILs, negatively influenced final vision.

Inhibition of corneal neovascularization after alkali burn: comparison of different doses of bevacizumab in monotherapy or associated with dexamethasone.

BACKGROUND: To compare the effects of different doses of bevacizumab with both saline and dexamethasone on inflammatory angiogenesis in the rat cornea induced by small chemical lesions. METHODS: Corneal chemical cauterization was performed on 24 rats. Animals were divided randomly into six groups and received a daily subconjunctival injection for 7 days of: balanced salt solution 0.1 mL or dexamethasone phosphate 4 mg/day or bevacizumab 2.5 mg/day, 3.75 mg/day, 5.0 mg/day or bevacizumab 5.0 mg/day + dexamethasone phosphate 4 mg/day. Clinical examination under slitlamp was performed daily for 7 days to evaluate corneal opacity and vessel size evolution. Computer assisted quantitative image analysis was used to measure the total corneal area covered by neovascularization. RESULTS: At final examination, the dexamethasone, bevacizumab 5.0 mg/day and dexamethasone + bevacizumab groups showed a significant lowering in corneal opacity score as compared with control (P = 0.024, P = 0.006 and P = 0.013, respectively). Also, a significant reduction on new vessels size score was observed. Surface of corneal neovascularization was significantly reduced in dexamethasone, bevacizumab 5.0 mg/day and dexamethasone + bevacizumab groups compared with control (P =0.045, P = 0.047 and P = 0.044, respectively). CONCLUSION: Our study demonstrates the ability of a 5.0 mg/day bevacizumab subconjunctival injection, in monotherapy or associated with dexamethasone, to cause a short-term involution of corneal neovascularization after corneal alkali burn. Combination of both of these treatments may have advantages to monotherapy approaches.

Optic nerve compression by an intraorbital megadolichoectatic ophtalmic artery.

A 47-year-old woman, physically active, presented with a history of progressive isolated right eye visual loss (20/200). Ophtalmological examination with Goldmann's perimetry showed a Marcus Gunn pupil, an optic disc temporal pallor and a central scotoma on the affected eye. CT scan and cerebral angiography demonstrated an abnormally wide and elongated (megadolichoectatic) intraorbital ophthalmic artery responsible for optic nerve compression in the optic canal. Pulse steroid therapy was chosen and allowed recuperation of right eye visual acuity to 20/20. A 3-months' follow-up was decided and to date, 1 year later, she fell back to 20/40 with a normal right eye visual field. The authors compare these clinical and radiological findings with intraorbital aneurysms and discuss the therapeutic options for this extremely rare form of vascular disease.

COQ6 mutation in patients with nephrotic syndrome, sensorineural deafness, and optic atrophy.

INTRODUCTION: Primary coenzyme Q10 (CoQ10) deficiencies are a group of mitochondrial disorders that has proven responsiveness to replacement therapy. Mutations in enzymes involved in the biosynthesis of CoQ10 genes are associated with these deficits. The clinical presentation of this rare autosomal recessive disorder is heterogeneous and depends on the gene involved. Mutations in the COQ2, COQ6, PDSS2, and ADCK4 genes are responsible for steroid-resistant nephrotic syndrome (SRNS), which is associated with extra-renal symptoms. Previous studies have reported COQ6 mutations in 11 patients from five different families presenting with SRNS and sensorineural deafness. CASE REPORTS: Our study reports the cases of two brothers of Turkish origin with renal failure and sensorineural deafness associated with COQ6 mutations responsible of CoQ10 deficiency. Optical symptoms were present in the eldest, that improved with Idebenone. CONCLUSION/DISCUSSION: For the first time, COQ6 mutation with optical involvement is associated with renal and hearing impairment. Although the response to replacement CoQ10 therapy was difficult to evaluate, we think that this treatment was able to stop the disease progression in both patients, and even to prevent the occurrence/development of optical and neurological impairment in the younger brother. Mitochondrial dysfunction secondary to CoQ10 deficiency should always be suspected in patients with SRNS and extra-renal symptoms. Early recognition of this genetic SRNS is mandatory since SRNS can be avoided by adequate treatment based on CoQ10 supplement or an analogue. All cases of primary CoQ10 deficiency should be treated at an early stage to limit the progression of lesions and prevent the emergence of new symptoms.

Clinical Study on the Initial Experiences of French Vitreoretinal Surgeons with Heads-up Surgery.

Purpose: To evaluate the initial experience of four experienced vitreoretinal surgeons, in France, with a three-dimensional (3-D) system, and to explore the potential advantages and disadvantages of this technology. We also report anatomical surgical outcomes of full-thickness idiopathic macular holes (MH) and primary rhegmatogenous retinal detachment (RRD), by using traditional microscopy and heads-up method. Methods: Four French retinal surgeons performed several types of ophthalmic surgeries with this new technology. To compare the 3-D system with ocular viewing, ergonomics, educational value, image sharpness, depth perception, field of view, technical feasibility, advantages and disadvantages, and expectations for the future, were assessed using a questionnaire. We also compared the same questionnaire with the answers of six Brazilian experienced vitreoretinal surgeons. For treating MHs, the surgeons performed 88 surgeries (44 with microscopy and 44 with 3-D). They performed 100 PPV for treating primary RRD (50 with ocular viewing and 50 with 3-D). The visualization method for each patient, as well as the assignment of each surgeon for a specific patient, were all randomly selected. Results: On the questionnaire, 3-D was preferred to traditional microscopy, except for technical feasibility; the type of surgery benefitting most from the 3-D was macula surgery and the least was anterior segment surgery; the most used by all is the black and white filter in patients with atrophic RPE during ILM peeling. Eighty-one (92.1%) MHs was successfully closed with one surgery and out of the 100 eyes with a primary RRD, the anatomical success after 3 months of follow-up was 91%, with no statistical significance between 3-D and ocular viewing. Conclusions: The surgeons in this study preferred 3-D to ocular viewing. Vitrectomy surgery to treat MHs and RRDs can be performed using the 3-D with the same efficiency as microscopy. Digital integration of 3-D and iOCT can be useful in some cases. With continuous refinement to improve the ability to visualize inside of the eye, this promising technology may enhance what we do as surgeons.

Expectations and fears of patients with diabetes and macular edema treated by intravitreal injections.

AIMS: Clinical outcomes of diabetic macular edema (DME) have been widely described, but data on diabetic retinopathy perceptions by diabetes patients are limited. The aim of this survey was to explore the lived experience, knowledge, fears and expectations about disease, and treatment in patients with diabetes and macular edema treated with intravitreal injections (IVTI) and to characterize patient profiles. METHODS: Cross-sectional survey including a preliminary qualitative phase (20 patients with DME, treated or treatment-naive, 5 female and 15 male, age 36-74 years) followed by a quantitative survey (116 patients treated with IVTI for DME). Data ASKIA Analyze (version 5.3.3.5) was used for descriptive statistics, and R software (version 3.4.1) for multiple correspondence analysis. RESULTS: The qualitative phase identified the wording used by patients and information helpful to propose modalities of response in the quantitative phase. In the quantitative survey (116 patients, mean age 66.6 years), most patients were treated with anti-vascular endothelial growth factor. Overall, 71.9% reported that the disease negatively affected their daily activities and 33.1% considered that regular visits to the ophthalmologist were disrupting their life. Treatment expectations differed significantly between patients in terms of disease experience (visit and injection schedules), fears and feelings, and relationship with physicians, allowing three patient profiles to be identified: "Worried" patients (n = 45) felt isolated and were worried about the need for repeated treatment and possible side effects. They were mainly active men aged < 60 with type I diabetes (T1D) and DME diagnosed for > 2 years; "Curious" patients (n = 21) experienced insufficient support and requested more information on their disease and existing treatments. They were mainly single women aged 60-69 years; "Passive" patients (n = 50) felt sufficiently informed by their ophthalmologist and were not concerned by DME. They were older (mean age: 70 years) and mainly type 2 diabetic men. CONCLUSIONS: Patients with diabetes and macular edema treated with IVTI form a heterogeneous group regarding fears and expectations. Different patient profiles were identified and need to be confirmed in larger studies. A better understanding of psychological profiles may optimize compliance of diabetic patients.

Diagnosis and treatment of peripheral exudative haemorrhagic chorioretinopathy.

PURPOSE: Peripheral exudative haemorrhagic chorioretinopathy (PEHCR) is a rare disorder that is often misdiagnosed. The aim of this study was to better characterise PEHCR and to assess treatment options. MATERIAL AND METHODS: Retrospective multicentric chart review. RESULTS: Of 84 eyes (69 patients) with PEHCR referred between 2005 and 2017, the most common referral diagnosis was choroidal melanoma (41.3%). Bilateral involvement was found in 21.7% of cases. Haemorrhagic retinal pigment epithelium detachment was the most common peripheral lesion (53.6%). Maculopathy was associated with peripheral lesions in 65.8% of cases. PEHCR lesions were mostly heterogeneous (58.8%) on B-scan ultrasonography. Choroidal neovascularisation was found in 10 eyes (26.3%) out of 38 eyes that underwent fluorescein angiography. Polyps were observed in 14 eyes (58.3%) out of 24 eyes that underwent indocyanine green angiography. Fifty-one eyes were treated (62.2%). Intravitreal injections (IVTI) of antivascular endothelial growth factor (VEGF) were the most used treatment (36.6%) before laser photocoagulation, photodynamic therapy, vitrectomy and cryotherapy. Only vitrectomy improved visual acuity. Most lesions (65.6%) regressed at the last follow-up visit. CONCLUSION: In case of PEHCR, multimodal imaging is useful to avoid misdiagnosis, to characterise PEHCR lesions and to guide treatment strategies. Regression of PEHCR lesions was observed in two-thirds of the patients. Vitrectomy improved visual acuity. More than a third of patients underwent anti-VEGF IVTI. Further studies are needed to assess IVTI's efficacy.

High prevalence of fastidious bacteria in 1520 cases of uveitis of unknown etiology.

The etiologic evaluation of uveitis is frequently unsuccessful when noninvasive methods are used. We conducted a prospective study to evaluate systematic screening for pathogens of uveitis. All patients with uveitis referred to the participating tertiary ophthalmology departments from January 2001 to September 2007 underwent intraocular and serum specimen collection. The standardized protocol for laboratory investigations included universal polymerase chain reaction (PCR)-based detection of any bacteria and mycoses, specific PCR-based detection of fastidious (difficult-to-grow) bacteria and herpes viruses, and culture of vitreous fluid. Sera were tested for fastidious bacteria. Among the 1321 included patients (1520 specimens), infection was diagnosed in 147 (11.1%) patients: 78 (53%) were caused by fastidious bacteria that included spirochetes, Bartonella species, intracellular bacteria (Chlamydia species, Rickettsia species, Coxiella burnetii), and Tropheryma whipplei; 18 by herpes viruses; and 9 by fungi. Bartonella quintana, Coxiella burnetii, Paracoccus yeei, Aspergillus oryzae, and Cryptococcus albidus were found to be associated with uveitis for the first time, to our knowledge. We recommend applying a 1-step diagnostic procedure that incorporates intraocular, specific microbial PCR with serum analyses in tertiary centers to determine the etiology of uveitis.

Short-term results of penetrating keratoplasty performed with the Femtec femtosecond laser.

PURPOSE: To evaluate the use of the Femtec femtosecond (fs) laser for penetrating keratoplasty (PK) in the treatment of corneal diseases. DESIGN: Prospective, nonrandomized clinical study. METHODS: Nine eyes of nine patients underwent surgery for PK. Five had pseudophakic bullous keratopathy, three had Fuchs dystrophy, and one presented in a keratoconus patient. A Femtec (20/10 PerfectVision; GmbH, Heidelberg, Germany) fs laser was used to create penetrating cuts on donor and recipient corneas. All patients were evaluated for uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), pachymetry, topography, and endothelial cell density (ECD). Scanning electron microscopy (SEM) was performed on corneal tissue after surgery. RESULTS: All eyes were treated successfully without intraoperative complications. The mean follow-up was 6 +/- 3 months. At the last postoperative examination mean BSCVA was 20/69 and there was a significant improvement (P = .08) in both UCVA and BSCVA. Mean astigmatism was 2.9 +/- 1.2 diopters. Mean ECD was 1194 +/- 465 cells/mm(2) with a mean cell loss after surgery of 49.8% +/- 19.8%. SEM displayed smooth rectilinear cut margins and minor remaining tissue bridges. One patient presented a retinal detachment three months after surgery that was successfully treated and two subjects showed an allograft rejection. CONCLUSION: Use of the Femtec fs laser was effective and safe to perform PK. Short-term visual results and refractive results are analogous to conventional PK or other fs laser-assisted PK studies. Longer-term follow-up of additional cases is necessary to precisely quantify the endothelial cell loss after fs surgery.

Corneal endothelial cell loss after cataract extraction by using ultrasound phacoemulsification versus a fluid-based system.

PURPOSE: To compare in vivo corneal endothelial cell loss (ECL) after fluid-based versus ultrasound phacoemulsification. METHODS: In this prospective randomized study, 2 groups of 21 patients underwent phacoemulsification with ultrasound (group 1) or a fluid-based system (group 2). A "divide and conquer" method with capsular bag lens implantation was performed. Cataracts graded up to nuclear opalescence 4.9 in Lens Opacities Classification System III (LOCS III) only were included. Endothelial cell density (ECD), percent hexagonality, endothelial cell area (ECA), coefficient of variation in cell size, and central corneal pachymetry were measured preoperatively, 7 days, 1 month, and 3 months after surgery. Statistical analysis was performed by using a 2-tailed Student t test. RESULTS: Average nuclear opalescence was identical in both groups (P = 0.908). Mean ECD was 1867 +/- 451 and 2031 +/- 400 cells/mm at 3 months postoperatively. Mean ECL was 498 +/- 415 (20.6% +/- 17.1%) and 302 +/- 302 cells/mm (13.3% +/- 13.2%) at 7 days, 589 +/- 342 (24.3% +/- 14%) and 254 +/- 214 cells/mm (11.2% +/- 9.1%) at 1 month, and 555 +/- 340 (22.9% +/- 14%) and 247 +/- 208 cells/mm (10.9% +/- 9.1%) at 3 months in groups 1 and 2, respectively. ECL was significantly lower for group 1 than for group 2 (P < 0.001) after the first postoperative month. A significant increase in ECA was also observed at the first and third (P = 0.012) postoperative months. CONCLUSIONS: Our study showed significantly lower ECL after phacoemulsification for a fluid-based versus an ultrasound system. The fluid-based method was safer than conventional ultrasound in cataract surgery, with a nuclear opalescence graded up to 4.9 in the LOCS III classification.

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

AIM: To assess the effectiveness and safety of intravitreal dexamethasone implants for treating post-surgical macular oedema, including Irvine-Gass syndrome refractory to first-line treatments. METHODS: Descriptive, observational, retrospective, consecutive, uncontrolled, multicentre, national case series. 50 patients were included in the study between March 2011 and June 2013 with a minimum 6 months follow-up. At baseline, each patient received a dexamethasone implant 0.7 mg (Ozurdex). Best-corrected visual acuity (BCVA), central subfield macular thickness (CSMT), and intraocular pressure (IOP) were measured at baseline and then monthly. The main outcome measure was the mean change in BCVA (in ETDRS letters (Early Treatment Diabetic Retinopathy Study): L) RESULTS: Baseline mean±SD BCVA was 55.7±15.4 L. At month 2, BCVA was 71.8±10.5 L and 61.2% of patients had an increase of more than 15 letters. Baseline mean CSMT was 544±117.2 µm and this decreased to 302 µm at month 2. Anatomic and functional recurrences were both first detected from month 3 and continued throughout follow-up, with values consistently above baseline. The peak in IOP was reached in month 1 with mean IOP of 15.3±4.6 mm Hg. Of the 39/50 patients followed up for 12 months, 49% received a second injection. The anatomic and functional response and safety patterns were similar to that obtained with the first intravitreal injection, demonstrating Ozurdex's reproducibility. However, more than half of the patients followed-up for at least 1 year presented neither functional nor anatomical recurrence. CONCLUSIONS: Ozurdex would appear to be an interesting alternative therapy for treating post-surgical macular oedema, including Irvine-Gass syndrome refractory to first-line treatments.

Benign intracranial hypertension and thyreostimulin suppression hormonotherapy.

PURPOSE: To report a case of benign intracranial hypertension occurring during thyreostimulin suppression hormonotherapy after thyroidectomy for papillary cancer. DESIGN: Interventional case report. METHODS: A 45-year-old woman underwent total thyroidectomy for a 7-mm papillary cancer. Seventeen years later, she experienced headache, dizziness, irritability, sensation of full head, and blurred vision of the right eye while being treated with a mix of L thyroxin (LT4) and liothyronin (LT3). Ophthalmological data (including the presence of papilledema), cerebroorbital magnetic resonance imaging, and lumbar pressure evaluation confirmed benign intracranial hypertension. RESULTS: Substitutive hormonotherapy was decreased under specialized surveillance, permitting remission of benign intracranial hypertension symptoms and papilledema. CONCLUSIONS: Benign intracranial hypertension is usually difficult to cure, and its association with thyroid hormonotherapy is rare. In our patient, tapering LT4 and withdrawal of LT3 until a euthyroidal state was obtained resulted in successful treatment of benign intracranial hypertension.

Screening for retinopathy of prematurity: results of a retrospective 3-year study of 502 infants.

PURPOSE: To describe the surveillance, results of screening, and treatment of retinopathy of prematurity (ROP) in a university hospital setting in southeast France. PATIENTS AND METHODS: Five hundred two premature infants were included in the screening protocol between January 1997 and December 1999. Criteria for inclusion in the study were a gestational age of 32 weeks or younger, a birth weight of less than 1,501 g, or both. The first fundus examination was performed between 4 and 6 weeks of life. Thereafter, fundus examination was performed in the absence of ROP every 2 weeks until complete retinal vasculature developed, gestational age of 50 weeks, or death. Examination was weekly in cases of retinopathy, biweekly if progression was ascertained, and less frequent only if regression was evident. Hospital records were reviewed to assess the presence or absence and eventual degree of ROP. RESULTS: Stage 1 was observed in 32 infants, and stage 2 in 11 infants; all of these cases regressed. Three cases of bilateral stage 3 (two threshold and one prethreshold) disease underwent diode laser peripheral retinal ablation and regressed. One infant with bilateral stage 3 disease who underwent peripheral cryoablative surgery progressed to stage 4A in one eye and 4B in the other eye and then underwent scleral buckling surgery in the second eye. CONCLUSIONS: Despite survival increasing with improved neonatal intensive care, the incidence of ROP does not appear to be increasing. In our center, the incidence appears to be lower than previously reported.