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.

Treatment of Non-infectious Uveitic Macular Edema with the Intravitreal Dexamethasone Implant.

PURPOSE: To describe the clinical outcome of phakic eyes with macular edema (ME) due to non-infectious uveitis treated with a dexamethasone intravitreal implant. METHODS: A retrospective analysis of 41 eyes treated with a total of 58 dexamethasone intravitreal implants was conducted. Best corrected visual acuity (BCVA), central retinal thickness (CRT) and complications data were collected. RESULTS: One month after the first implant, even as CRT improved significantly in most eyes (p<0.001), 31.7% showed no improvement in BCVA. At 6 months post-implantation, CRT and BCVA had deteriorated in up to 70% of patients. Thirteen eyes were re-implanted, with a similar effect to that of the first implant. Ocular hypertension developed in 36.2% of eyes, and three eyes had cataract surgery, all in eyes with repeated implants. CONCLUSIONS: The dexamethasone intravitreal implant can be safely used to treat ME due to non-infectious uveitis, but with a limited and short effect on BCVA.

Bilateral macular serous retinal detachment revealing acute myeloblastic leukemia.

PURPOSE: To report a case of bilateral serous retinal detachment revealing acute myeloblastic leukemia. METHODS: A 31-year-old man presenting with decreased vision in both eyes, 20/50 in the right eye and 20/32 in the left eye, was submitted to a complete ophthalmologic and systemic evaluation. RESULTS: Fundus biomicroscopy, fluorescein and indocyanine green angiography, and spectral domain optical coherence tomography showed bilateral serous retinal detachment and signs of choroidal ischemia. Enhanced depth imaging spectral domain optical coherence tomography allowed a precise examination of the choroid, by showing an overall thickening of the choroid (749 µm in the right eye and 728 µm in the left eye) and disappearance of the normal hyporeflective visualization of the choroidal vessels. On systemic investigation, the patient was diagnosed with acute myeloblastic leukemia. After systemic chemotherapy, visual acuity improved to 20/20 in both eyes, with resolution of the bilateral serous retinal detachment and choroidal changes. CONCLUSION: Bilateral serous retinal detachment may be a presenting sign of acute myeloblastic leukemia. Examination of the choroid using enhanced depth imaging spectral domain optical coherence tomography may suggest the etiology and contribute to early diagnosis and treatment.

Acute posterior multifocal placoid pigment epitheliopathy as the initial manifestation of sarcoidosis.

PURPOSE: To report an undiagnosed case of systemic sarcoidosis manifesting with bilateral acute posterior multifocal placoid pigment epitheliopathy (APMPPE). CASE REPORT: A 26-year-old Caucasian man was referred for management of unilateral visual loss together with a paracentral scotoma developing 2 weeks after a flu-like syndrome. Clinical signs and ancillary diagnostic investigations suggested APMPPE. Laboratory tests demonstrated elevated serum angiotensin converting enzyme and lysozyme levels. Chest CT-scan disclosed moderate hilar lymph node calcifications but QuantiFERON-TB gold test was negative and bronchoalveolar lavage and biopsies were unremarkable. Accessory salivary gland biopsy disclosed epithelioid and gigantocellular granuloma formation without caseum, confirming a diagnosis of sarcoidosis. The fellow eye was involved a few days later and the patient complained of dyspnea. Echocardiography disclosed severe granulomatous myocardial infiltration and high dose corticosteroids and intravenous cyclophosphamide were initiated. Systemic treatment controlled both cardiac and ocular lesions, and was tapered accordingly. CONCLUSION: The constellation of "white dot syndromes" and systemic symptoms necessitates a general work-up to exclude granulomatous disorders such as sarcoidosis or tuberculosis. Delayed diagnosis of cardiac sarcoidosis may have life-threatening consequences and the ophthalmologist may be the first physician to diagnose the condition.