Retinal Vein Occlusions: Therapeutic Switch in Macular Oedema Treatment with a 12-Month Follow-Up.

PURPOSE: To compare the visual and anatomical outcomes of patients with macular oedema secondary to retinal vein occlusion (RVO) after a switch from bevacizumab to intravitreal injection of a dexamethasone implant (IVI-DEX) or conversely. METHODS: 48 patients - 40 in the antivascular endothelial growth factor (VEGF) DEX sequence (AD group), 8 in the DEX anti-VEGF sequence (DA group) - were included in this multicentre retrospective study and evaluated at baseline, 1, 3, 6 and 12 months after the switch. The outcome measurements were visual acuity (VA) and central macular thickness (CMT) evaluated by spectral domain optical coherence tomography. Patients were defined as 'good responders' if CMT was ≤ 300 µm after the switch. RESULTS: VA significantly improved at 1 month in the AD group (p = 0.03) but not in the DA group (p = 0.40). CMT decreased significantly in the AD group at 1, 6 and 12 months (p = 0.002, p = 0.005 and p = 0.002, respectively). In the DA group, VA did not change from baseline at any time point, and CMT decreased at 1 month (p = 0.02) but not later on. CONCLUSIONS: In patients with macula oedema secondary to RVO, the switch from bevacizumab to IVI-DEX seems more beneficial in terms of short-term VA and long-term reduction of CMT than the DEX anti-VEGF agent sequence.

Severity of manchineel fruit (Hippomane mancinella) poisoning: A retrospective case series of 97 patients from French Poison Control Centers.

In this retrospective series of 97 cases of manchineel fruit ingestion reported to French Poison Control Centers between 2009 and 2017, we investigated cases of poisoning due to manchineel fruit (from the Hippomane mancinella tree). This fruit is known to be responsible for oropharyngeal and gastrointestinal tract lesions and possibly hypotension and bradycardia (previously attributed to the presence of physostigmine). The most commonly observed clinical signs were oropharyngeal pain, abdominal pain, diarrhea and oropharyngeal irritation. No major gastrointestinal tract lesions were observed in the five cases in which upper gastrointestinal (GI) endoscopy was performed. One case of laryngeal edema and one case of bradycardia were observed, but analysis of the harvested fruits did not confirm the presence of physostigmine. Ingestion of manchineel fruit can cause mild abdominal pain and digestive irritation, requiring medical attention. Rarely, when several fruits have been ingested, severe oropharyngeal injury or hemodynamic disorders may require otorhinolaryngological consultation or cardiac monitoring for several hours, respectively.

Treatment of refractory open-angle glaucoma using ultrasonic circular cyclocoagulation: a prospective case series.

OBJECTIVE: To evaluate the efficacy and safety of the ultrasonic circular cyclocoagulation (UC(3)) procedure in patients with refractory primary open-angle glaucoma. RESEARCH DESIGN AND METHODS: Prospective non-comparative interventional case series performed in two French glaucoma centers. Twenty-eight eyes of 28 patients with primary open-angle glaucoma, intraocular pressure (IOP) >21 mmHg, an average of 1.4 failed previous surgeries and an average of 3.8 hypotensive medications were insonified with a therapy probe comprising six piezoelectric transducers. The six transducers were activated and all patients were treated with a 6 second exposure time. Complete ophthalmic examinations were performed before the procedure, and at 1 day, 1 week, 1, 2, 3, 6 and 12 months after. MAIN OUTCOME MEASURES: Primary outcomes were surgical success (defined as IOP reduction from baseline ≥20% and IOP >5 mmHg) at the last follow-up visit, and vision-threatening complications. Secondary outcomes were mean IOP at each follow-up visit compared to baseline, medication use, complications, and re-interventions. RESULTS: IOP was significantly reduced (P < 0.05), from a mean preoperative value of 29.0 ± 7.2 mmHg (n = 3.8 hypotensive medications) to a mean value of 21.6 ± 9.4 mmHg at last follow-up (n = 3.8 hypotensive medications and n = 1.29 procedures) (mean IOP reduction of 26%). Complete success (IOP reduction >20% without re-intervention and without hypotensive medications adjunction) was achieved in 50% of eyes at last follow-up (mean IOP reduction of 45% in these same eyes) and qualified success (IOP reduction >20% with possible re-interventions) was achieved in 68% of eyes at last follow-up. No major intra- or post-operative complications occurred. CONCLUSIONS: UC(3) procedure seems to be an effective and well tolerated method to reduce intraocular pressure in patients with primary open-angle glaucoma. Studies directly comparing the efficacy and safety of the UC(3) procedure with that of trabeculectomy or diode laser are needed.