[Macular pigment and age-related macular degeneration. Clinical implications]. / Pigment maculaire et dégénérescence maculaire liée à l'âge. Implications cliniques.

The potential impact of macular pigment on the development of age-related macular degeneration (AMD) is currently a major research avenue. The role of oxidative damage in the pathogenesis of AMD has been recently confirmed by the results of a large randomized clinical trial, the AREDS (Age-Related Eye Disease Study). This study has established that high-dose supplementation with vitamins C and E, beta carotene, and zinc might prevent AMD progression and visual acuity loss in a large but determined subset of patients. Macular pigment components (mainly lutein and zeaxanthin) are highly resistant to free radicals. Moreover, extensive data from clinical, epidemiological and experimental studies suggest that lutein and zeaxanthin might protect against the development of AMD. Furthermore, an additional intake of lutein and/or zeaxanthin seems to induce an increase of the density of the macular pigment. However, a careful review of the available data suggest that only future randomized clinical trials will allow to determine the exact role of lutein and zeaxanthin in the prevention of AMD.

Eligibility for treatment and angiographic features at the early stage of exudative age related macular degeneration.

AIMS: To determine the eligibility for laser photocoagulation treatment or for photodynamic therapy (PDT) with verteporfin in eyes at the earliest stage (first month of symptoms) of exudative age related macular degeneration (AMD) based on fluorescein angiographic (FA) features; to evaluate the potential contribution of indocyanine green angiography (ICG-A) for occult choroidal neovascularisation (CNV) at this stage. METHODS: Retrospective review of 252 consecutive patients (269 eyes) examined within the first month of symptoms of exudative AMD. RESULTS: On FA, 97 eyes (36%) had classic CNV alone. Occult CNV associated with fibrovascular retinal pigment epithelium detachments (PEDs) was observed in 71 eyes (26%) and without fibrovascular PED in 101 eyes (38%). 91 eyes (34%) met the Macular Photocoagulation Study criteria for laser photocoagulation. 53 eyes (20%) met the Verteporfin In PDT (VIP) or Treatment of AMD with PDT (TAP) studies criteria. By ICG-A, occult CNV was visualised as focal spots in 49% of eyes examined within 15 days v 32% of eyes examined between 16 and 30 days after the onset of symptoms (p=0.07). 8.5% of late staining plaques disclosed in eyes examined within 15 days were combined with focal spots v 36% in eyes examined between 16 and 30 days (p<0.01). CONCLUSIONS: Early examination of eyes with exudative AMD would allow the treatment of 47% of eyes. 60% of eyes with subfoveal CNV would be eligible for PDT with verteporfin. Up to half of eyes with occult CNV would be converted by ICG-A into well delineated focal spots.

[Age-related macular degeneration and apoptosis]. / Dégénérescence maculaire liée à l'âge et apoptose.

Several studies suggest that apoptosis might play a major role in age-related macular degeneration. Apoptosis in retinal pigment epithelium cells undergoing severe oxidative stress has been reported and could therefore be involved in the pathogenesis of AMD. The processes of drusen formation seem to be similar to the processes described in apoptosis. Moreover, apoptosis appears to be involved in the early outgrowth of choroidal neovascular membranes as well as in the development of fibrotic scars at a later stage. Targeting apoptotic pathways should therefore be considered as a possible treatment approach for AMD.

[Decompensation of a cirsoid aneurysm: a case report]. / Décompensation d'un anévrysme cirsoïde. A propos d'un cas.

We report a case of a 27-year-old woman with a cirsoid aneurysm, also called congenital arteriovenous communication of the retina. The cirsoid aneurysm, stage I according to Archer's classification, was revealed by a serous retinal detachment. The exudation resolved, and acuity was recovered after a short time, but exudation recurred during the 5 years of follow-up. Exudation of type I cirsoid aneurysm is rare. The clinical and pathogenic features are discussed.

[Comparison of macular limited translocation and photodynamic therapy for management of choroidal neovascularization in degenerative myopia: a retrospective study]. / Etude rétrospective comparant la translocation maculaire limitée et la photothérapie dynamique dans la néovascularisation choroïdienne rétrofovéale de la myopie forte.

PURPOSE: To analyze the results of limited macular translocation (MT) and photodynamic therapy (PDT) in subfoveal choroidal neovascularization due to degenerative myopia, with a minimum follow-up of 12 months. METHODS: Retrospective review of 55 consecutive patients: 31 eyes were treated using PDT and 24 were operated on with the limited macular translocation technique with chorioscleral infolding described by de Juan. Before and after each treatment, a complete examination comprised visual acuity, fundus examination, fluorescein angiography, and optical coherence tomography. Mean follow-up was 14 months in the PDT group and 19 months in the MT group. RESULTS: The improvement in visual acuity was better in the MT group than in the PDT group and was correlated with younger age (p<0.001). At month 12, visual acuity improved by 3 ETDRS lines or more in 6 six eyes of the PDT group (19%), with no improvement over 6 lines. In the MT group, visual acuity improved by 3 lines in 14 eyes (58%) including 8 eight eyes (33%) with an improvement of 6 lines or more. Final visual acuity remain unchanged (+/-2 lines) in 16 eyes of the PDT group (66%) and 8 eight eyes of the MT group (33%), and decreased in 9 nine eyes in the PDT group (29%) versus 2 two eyes in the MT group (8%). Mean gain in visual acuity at 12 months was +3.5 ETDRS lines in the MT group and -0.1 line in the PDT group (p=0.001). The mean displacement of the fovea after translocation was 950 microm. The mMean number of PDT treatments was 2.3 during the 12-month follow-up. CONCLUSIONS: Limited macular translocation allowed provided a significant improvement in visual acuity in some eyes with subfoveal neovascularization in myopia, especially in young patients, and resulted in a moderate rate of complications. Longer follow-up and further controlled and randomized studies are required to confirm these encouraging findings.