Prevalence and significance of fovea plana in patients with epiretinal membrane.

INTRODUCTION: Fovea plana is indicative of an immature inner retina, yet its association with epimacular membrane (ERM) remains unexplored. This study aims to investigate the prevalence of fovea plana in the contralateral eye of patients diagnosed with ERM. METHODS: A retrospective analysis was conducted on consecutive patients in a monocentric tertiary ophthalmic department between January and April 2021. The study included all patients referred for ERM, with dense optical coherence tomography (OCT) B-scans utilized to assess the incidence of fovea plana in the contralateral eye. Patients with bilateral ERM were excluded from the analysis. RESULTS: Out of 181 patients, 26 exhibited fovea plana in the contralateral eye, resulting in an incidence rate of 14.3%. Demographic characteristics, OCT patterns, and indications for surgery did not differ significantly between patients with and without fovea plana. DISCUSSION: The prevalence of fovea plana in patients with ERM did not exhibit a statistically significant increase compared to the reported incidence in patients undergoing preoperative cataract surgery. CONCLUSION: In our cohort, the incidence of fovea plana in patients with ERM was determined to be 14.3%.

Incidence and clinical significance of fovea plana in the French population with age-related cataract.

BACKGROUND: Fovea plana is defined as an immature macula diagnosed by OCT, showing the unusual shunt of the inner retinal layers into the fovea. The incidence of fovea plana in the adult population remains to be determined. The aim of this study was to determine the incidence of fovea plana in the French population with age-related cataract. METHODS: Consecutive patients who underwent cataract surgery in Rothschild Foundation Hospital, France, between January and March 2021, with preoperative analyzable OCT scans available, were retrospectively screened in order to determine the incidence of fovea plana in these population. Ophthalmological characteristics of patients were reported, and detailed. RESULT: Fovea plana was encountered in 20 out of 204 patients during the 3 months corresponding to an incidence of 9.8%. One of those patients had stage 2 fovea plana. CONCLUSION: Although fovea plana is defined as an immature macula, it is not rare in preoperative population. This macular aspect was not associated with poor visual acuity in our cohort.

Simultaneous perception of prosthetic and natural vision in AMD patients.

Loss of photoreceptors in atrophic age-related macular degeneration (AMD) results in severe visual impairment. Since the low-resolution peripheral vision is retained in such conditions, restoration of central vision should not jeopardize the surrounding healthy retina and allow for simultaneous use of the natural and prosthetic sight. This interim report, prespecified in the study protocol, presents the first clinical results with a photovoltaic substitute of the photoreceptors providing simultaneous use of the central prosthetic and peripheral natural vision in atrophic AMD. In this open-label single group feasibility trial (NCT03333954, recruitment completed), five patients with geographic atrophy have been implanted with a wireless 2 x 2 mm-wide 30 µm-thick device, having 378 pixels of 100 µm in size. All 5 patients achieved the primary outcome of the study by demonstrating the prosthetic visual perception in the former scotoma. The four patients with a subretinal placement of the chip demonstrated the secondary outcome: Landolt acuity of 1.17 ± 0.13 pixels, corresponding to the Snellen range of 20/460-20/565. With electronic magnification of up to a factor of 8, patients demonstrated prosthetic acuity in the range of 20/63-20/98. Under room lighting conditions, patients could simultaneously use prosthetic central vision and their remaining peripheral vision in the implanted eye and in the fellow eye.

Foveal hypoplasia in parents of patients with albinism.

BACKGROUND: Albinism is a group of genetic disorders characterized by general skin and retinal hypopigmentation. It is in most cases an autosomal recessive condition. Foveal hypoplasia (FH) is one of the main criteria for the diagnosis of albinism. The aim of this study was to analyze the macular profile of the parents of patients with albinism. METHODS: This study included a case series of 27 patients with albinism seen in Rothschild Foundation between April 2017 and February 2020. Spectral-domain optical coherence tomography (SD-OCT) and OCT angiography (OCT-A) were performed in every patient when possible and in every available parents. FH was graded according to Thomas' classification based on OCT. Next generation sequencing-based gene panel testing was performed in parents and children when a FH was detected on OCT in a parent. RESULTS: Twenty-seven patients with albinism were examined. Nine parents had FH based on the OCT B-scan (33%). In parents without FH based on the SD-OCT B-scan (67%), OCT-A showed a reduced avascular zone in the deep vascular plexus in 4 parents. Six parents carried variants that could explain their phenotype, including TYR R402Q hypomorphic alleles. CONCLUSION: This study showed the presence of FH in parents of patients with albinism, and aimed to genetically explain this phenotype.

[Efficacy and tolerance of Latanoprost given as a first intention in the treatment of primitive open angle glaucoma in African melanoderm]. / Efficacité et tolérance du Latanoprost donné en première intention dans le traitement du glaucome primitif a angle ouvert chez le mélanoderme africain.

OBJECTIVE: To assess the reduction in IOP and ocular symptoms in patients newly diagnosed with POAG and treated with latanoprost as monotherapy. PATIENTS AND METHOD: A multicentric, cross-sectional, descriptive study was conducted. We included adults newly diagnosed with POAG. All patients received one drop of preserved latanoprost 0.005% in each eye every night for 12 weeks. Changes in IOP and ophthalmic signs and symptoms were assessed during and at the end of treatment. RESULTS: A total of 524 patients were included, with a participation rate of 93% at 12 weeks. The mean age was 52.79±17.33 years, and the sex ratio M/F was 1.39. At inclusion, the mean IOP was 21.68±9.72mmHg. After 2 weeks of treatment, the mean IOP was 15.49±5.81mmHg, for a reduction of 28.55%. After 12 weeks of treatment, the mean IOP was 13.16±3.54mmHg, for a reduction of 39.30%. The main symptom recorded was a gritty foreign body sensation, the frequency of which was 4.72% at W2 and 2.45% at W12. The main sign was hyperemia (4.33% at W2 and 1.84% at W12). CONCLUSION: Latanoprost given as first-line monotherapy in POAG in blacks considerably reduces IOP. The incidence of side effects remains low; it is higher at the start of treatment.

[Susac syndrome: study of five cases]. / Syndrome de Susac: étude de cinq cas.

INTRODUCTION: Susac syndrome is a rare microangiopathy, responsible for small cerebral, retinal and cochlear infarcts. The classic clinical triad includes multiple neurologic signs (from headaches to coma), retinal branch occlusions and sensorineural hearing loss. METHODS: We report a series of five patients with Susac syndrome followed in our department from 1997 to 2007. RESULTS: There were four women and one man (mean age at onset: 35.2 years). Clinical symptoms at onset were neurological (n=1), ophthalmological (n=1), auditory (n=1) and clinical triad (n=2). Neurologic symptoms included encephalopathy (n=2), headache (n=5), transient ischemic attacks (n=1). Brain MRI showed T2 lesions in the white and grey matter, corpus callosum and gadolinium-enhanced punctiform lesions. Cerebrospinal fluid contained an elevated protein level in three cases. Immunologic treatments (steroids [n=4], cylophosphamid [n=3], intravenous immunoglobulins [n=5]) associated with aspirin and/or oral anticoagulants, despite early relapses (n=2), led to dramatic clinical improvement (n=5). CONCLUSION: Due to its polymorphism the SS is difficult to diagnose when the clinical triad is lacking. In the absence of clinical trial and consensus treatment is empiric and based on supposed pathogenesis.

[Variability of chloroquine and hydroxychloroquine retinopathy among various ethnicities]. / Différences ethniques parmi les patients souffrant de toxicité maculaire aux antipaludéens de synthèse.

INTRODUCTION: Current screening recommendations for chloroquine (CQ) and hydroxychloroquine (HCQ) retinopathy are based on central 10°C static perimetry and a high-resolution SD-OCT with a special attention to the inferior part of the macula where the toxicity usually starts by ellipsoid zone disruption. However, Melles and Marmor, have recently shown a great variability in the topography of the initial toxicity observed among various ethnicities, which is important to keep in mind so as not to miss early toxicity in certain subgroups of patients. METHODS: Review of the literature. RESULTS: Ethnic differences have been shown regarding the topography of the initial retinal toxicity of CQ and HCQ, particularly between Caucasian and Asian subjects. In Caucasians, the first signs of toxicity are more often localized in the inferior para-foveal area associated with a decrease in retinal sensitivity in the upper 10°C visual field. However, in Asian subjects, the first signs of toxicity appear more pericentral (still inferior) with an extramacular pattern that could be missed by the usual 10°C visual field screening. DISCUSSION/CONCLUSION: The pathophysiology of these ethnic differences is unknown and may be due to distinct genetic predisposition to CQ and HCQ toxicity. Screening strategies should be adjusted to the ethnicity and performed in Asian subjects with larger visual fields (30°C), along with SD-OCT, looking for ellipsoid disruption≥8°C from the fovea. The recognition of this pericentral topography and an adjusted screening protocol should avoid late diagnosis in Asians treated with CQ and HCQ.

[Update on recommendations for screening for hydroxychloroquine retinopathy]. / Mise à jour des recommandations sur la toxicité rétinienne des antipaludéens de synthèse.

INTRODUCTION: Recommendations for screening for chloroquine (CQ) and hydroxychloroquine (HCQ) retinopathy have recently been changed by the American Academy of Ophthalmology, taking into account new published data on toxicity prevalence, risk factors, location of onset in the retina and the efficacy of screening tests. METHODS: Literature review. RESULTS AND DISCUSSION: The risk of developing CQ or HCQ retinopathy depends on the daily dose and duration of treatment. At recommended doses, the risk is<1 % at 5 years, <2 % at 10years but increases to about 20 % after 20years of treatment. The maximum recommended daily dose is 5.0mg/kg for HCQ and 2.3mg/kg for CQ. The two main risk factors are the daily dose and duration of treatment. The presence of kidney failure and treatment with tamoxifen are also significant risk factors. A baseline examination should be performed at the initiation of treatment to rule out pre-existing maculopathy. The screening is then annual and starts from the 5th year of treatment. The two tests recommended for screening are the automated visual field and spectral domain OCT. Multifocal ERG and autofluorescence fundus imaging are only carried out secondarily to confirm the pathology.

[Classification of vitreomacular adhesion and macular holes]. / Classification des adhérences vitréomaculaires et trous maculaires.

BACKGROUND: Optical coherence tomography has significantly changed the approach to vitreomacular diseases, including macular holes (MH). OCT provides information on differential diagnoses (lamellar hole, pseudo-hole), the MH size, the status of the vitreous, and the status of the various retinal layers. The evolution of diagnostic tools and treatment justifies the need for an update of the current classification of vitreomacular diseases. METHOD: A group of retina specialists met several times to discuss the international classification, recently published by The International Vitreomacular Traction Study Group, focusing on vitreomacular adhesion (VMA), vitreomacular traction (VMT) and MH. It was compared to the classification currently used in France, based on the ophthalmoscopic system of Gass, then further delineated by Gaudric's OCT studies, in order to suggest a French adaptation to the international classification. RESULTS: An adapted classification for clinical use in France and in connection with the international classification is proposed. VMA are classified as an "associated" or "isolated" VMA respectively with or without macular disease. MH are distinguished as "primary" or "secondary" MH depending on whether the etiology is known or not, and classified as "small", "medium" and "large" depending on the size of the hole, and according to the presence or absence of VMT. Finally, VMT are described according to presence or absence of an epimacular membrane and according to the width of the adhesion.

[Use of liquid perfluorocarbons in vitrectomy for difficult cases of proliferative diabetic retinopathy]. / Utilisation des perfluorocarbones liquides au cours de la vitrectomie pour cas difficiles de rétinopathie diabétique proliférante.

PURPOSE: Thanks to their physical properties, could perfluorocarbon liquids (PFCL) be useful during vitrectomy for severe cases of proliferative diabetic vitreo-retinopathy (PDVR)? METHODS: Among 120 vitrectomies for PDVR performed in a period of time from August 1992 to July 1993, we reviewed 24 cases with a minimal follow-up of six months for which we have used PFCL as intraoperative tool. Among these eyes, three (12%) were preoperatively attached, seven (29%) presented with a tractional retinal detachment sparing the macular area and 14 (59%) with a retinal detachment involving the macula. The indication for PFCL injection was either to flatten the retina in case of iatrogenic tear or retinotomy (15/24 eyes) or to stop a bleeding coming from the optic disc (9/24). The aim was to allow a good laser endophotocoagulation in all the cases and to inject an intraocular tamponade on a reattached retina if needed. As final tamponade, silicone oil was used in 10 eyes, gas in nine eyes and none in five eyes. RESULTS: At the end of the study, 20 (83%) eyes had a totally reattached retina and four (17%) a detached retina. The postoperative compared to the preoperative visual acuity was improved in 13 eyes (54%), unchanged in seven eyes (30%) and decreased in four eyes (16%). In one case (4%), some droplets of PFCL were noticed in the vitreous cavity, under the silicone oil bubble, with a good clinical tolerance. No specific complication of PFCL injection could be found in the 23 other eyes. CONCLUSION: In some selected cases of severe PDVR, the use of PFCL may help to flatten the retina, to stop bleeding from the optic disc and to perform a good endolaser photocoagulation. This allows to achieve good anatomical and visual results with few specific complications.

[Use of perfluoro-octane liquid in the treatment of giant tears with inversion of the retina: preliminary results]. / Utilisation du perfluoro-octane liquide dans le traitement des déchirures géantes avec inversion de la rétine: résultats préliminaires.

Five consecutive cases of giant tears with retinal inversion were easily and successfully treated using vitrectomy and silicone oil injection after repositioning of the retina with perfluoro-octane. The good initial results show the interest of this technique compared with the incarcerations or with the manipulation of the retina and of the perfluoro-octane compared with the other liquid perfluorocarbons.

[Treatment of preretinal retrohyaloidal hemorrhage: value of early argon laser photocoagulation]. / Traitement des hémorragies prérétiniennes rétro-hyaloïdiennes: intérêt de la photocoagulation précoce au laser à l'argon.

Within the first three or four days after occurrence of a premacular subhyaloidal hemorrhage, the posterior vitreous boundary layer may be lacerated by argon laser coagulation in such a way that the blood flows into the vitreous body, where it is absorbed within a few weeks. Older premacular hemorrhages under an intact vitreous boundary layer, typically green-white in color, have to be treated by more invasive vitreosurgical procedures.

[Systematic search of the posterior vitreous cortex during vitrectomy. Technique, complications and results]. / Recherche systématique du cortex vitréen postérieur lors de la vitrectomie. Technique, complications et résultats.

We present the results of a prospective study trying to answer the question: when a clinical or echographic premacular vitreous detachment occurs, is it still possible to find a preretinal membrane at the surface of retina? We looked for such a membrane in 50 consecutive vitrectomies for various indications. We found and removed such a membrane in 42 cases but were unable to obtain histological examinations. Our conclusions are: most of the time, the diagnosis of total vitreous detachment is very difficult and the finding of a premacular membrane during vitrectomy is a frequent event.

[Value of prevention of congenital toxoplasmosis]. / Intérêt de la prévention de la toxoplasmose congénitale.

PURPOSE: To verify incidence of toxoplasmosis seroconversion during pregnancy and the interest of treating the mother. METHODS: Among 7044 infants born between January 1989 and December 1993, 78 (1.1%) born to mothers who developped toxoplasmosis seroconversion during pregnancy were followed. RESULTS: Among 69 mothers treated, there were only 9 cases of congenital toxoplasmosis (13.4%) including only 3 cases of patent toxoplasmosis. CONCLUSION: Treating the mother is an effective means of preventing toxoplasmosis. The cost of verifying seronegativity in women during pregnancy could be reduced by primary prevention.

[Anterior fibrovascular proliferation. A rare complication of vitrectomy for proliferative diabetic retinopathy]. / La prolifération fibro-vasculaire antérieure. Une complication rare de la vitrectomie pour rétinopathie diabétique proliférante.

PURPOSE: To present clinical and therapeutic features of anterior fibrovascular proliferation, a severe complication of vitrectomy for diabetic retinopathy. METHODS: Among 153 vitrectomies for complication of diabetic proliferative vitreo-retinopathy, six cases of anterior fibro-vascular proliferation were found. All presented initially with a tractional retinal detachment associated in some cases with a vitreous hemorrhage. The complication occurred after a mean follow-up of three months after initial vitrectomy, marked by intravitreal bleeding, rubeosis iridis and hypotony. A reoperation with peeling of proliferation, lensectomy, extensive panretinal photocoagulation, encircling band and silicone oil injection allowed reattachment of the anterior retina in all the six cases. RESULTS: A reproliferation occurred in five cases, requiring revision of dissection. Finally, silicone oil was removed in three cases, was definitively left in one eye and was not removed in two eyes. Final visual acuities range from 1/50 to 2/10. CONCLUSION: Anterior fibrovascular proliferation is an unfrequent complication after vitrectomy for diabetic retinopathy. The prognosis is poor, in spite of aggressive vitreoretinal surgery including repeated dissection and extensive photocoagulation.

[Long-term results of successful surgical treatment of retinal detachment by vitrectomy and silicone oil injection. Effect of removal of the tamponade on further complications]. / Evolution à long terme des yeux opérés avec succès de décollement de rétine par vitrectomie et injection d'huile de silicone. Effet de l'ablation du tamponnement sur les complications.

We present, with a minimal follow up of six months, the results of 118 silicone oil removals following successful treatment of retinal detachment by pars plana vitrectomy and silicone oil injection. A recurrent retinal detachment occurred in 8.5% of cases, 13% of the 61 phakic eyes at the time of silicone oil removal maintained a clear lens, 29.6% of the eyes had a raised intraocular pressure and 6.8% had a keratopathy. The visual acuity improved in 72.8% of eyes after silicone oil removal. The main reasons for a late decrease in visual acuity were recurrence of the detachment, hypertonia, chronic hypotonia and keratopathy. All the eyes with late complications after silicone oil removal had a clinically significant droplet dispersion in the anterior chamber. Only complete and early silicone oil removal seems to decrease the complication rate.

[Posterior luxation of lens or implant: surgical treatment using a perfluorocarbon solution. Technique and results of 13 cases]. / Luxation postérieure du cristallin ou d'un implant: traitement chirurgical utilisant un perfluorocarbone liquide. Technique et résultats à propos de 13 cas.

We used perfluorocarbon liquids in the management of 6 cases of posterior dislocation of the lens and 7 cases of (sub-) luxation of a posterior chamber intraocular lens (IOL). The perfluorocarbon liquid was injected into the vitreous cavity after complete vitrectomy, to bring back the lens or IOL to the posterior chamber where it can be easily removed. The main characteristics of perfluorocarbon liquids used in this indication are their high specific gravity and their good surface tension. Because of these two qualities, when injected in a vitrectomized eye, the perfluorocarbon liquid forms a bubble, filling the vitreous cavity from the posterior pole to the ora serrata with the dislocated lens or IOL floating on its surface. We found this technique to be helpful and quite atraumatic in this difficult surgical situation. Complications included regressive corneal edema in 6 cases and retinal dialysis with localized detachment in 3 cases.

[Adverse effects and complications of argon laser trabecular retraction: practical results]. / Incidents et accidents de la trabéculorétraction au laser à l'argon: conséquences pratiques.

Argon laser trabeculoplasty is learned and used much more easily than filtration surgery. This explains the danger of its being abusively employed, as well as the existence of complications such as an aggravated glaucoma condition (1 to 3% of the cases). In 253 eyes afflicted with various forms of chronic open angle glaucoma with follow-ups ranging from at least 6 months to 4 years, the following complications were disclosed: 3% of the cases required treatment for severe anterior uveitis; anterior synechiae occurred in 23%, including one case of circular anterior synechiae and 4 other cases in which acute angle closure glaucoma developed several months later; trabecular hemorrhage in 6%; post operative intra ocular pressure elevation in 13%. This last complication is the most dangerous especially in advanced glaucoma: it very frequently happens during the first post operative hours in the absence of preventive treatment and it can arise up to three weeks after the procedure. In 33 cases upon 253 (13%), the pressure increase, despite a systematic preventive treatment, ranged from +3 mmHg to +16 mmHg above the baseline level in more than two thirds of these particular cases (+5 mmHg in only 7.5% of the cases and +9 in only 3.5%). In 59 eyes treated by less intensive trabeculoplasty (50 burns upon 180 degrees trabeculoplasty ring), the pressure increased in only 3.4% of the cases but the long term efficacy was reduced. Argon laser trabeculoplasty complications are less numerous than those of surgery, but some of them, i.e. intra ocular pressure elevation, can be very serious and must lead to a study of the risk-benefit ratio corresponding to the glaucoma stage which is to be treated.

[Results of early removal of intra-ocular silicone after vitreoretinal surgery]. / Résultats du retrait précoce du silicone intra-oculaire après chirurgie vitréo-rétinienne.

Report of the anatomic results of early silicone oil removal in 23 eyes successfully treated by vitrectomy and silicone oil injection after membrane peeling. After cicatrization of retinopexy using panretinal photocoagulation, the silicone oil was removed. The retina remained attached in 87% of cases. The utility of laser retinopexy before silicone oil ablation is discussed.

[Surgery of idiopathic epiretinal macular membranes. A retrospective statistical study of the functional result. Apropos of 42 treated cases]. / Chirurgie des membranes épirétiniennes maculaires idiopathiques. Etude statistique rétrospective du résultat fonctionnel. A propos de 42 cas traités.

Presentation of 42 glial idiopathic epiretinal macular membranes, surgically removed. Complications are rare. The functional improvement is greater if the operation is carried out when the visual acuity is low but the final result is better if eyes are operated when the visual acuity is still good. The main difficulties are the impossibility to detach the membrane, and the iatrogenic tears, which often need an internal tamponade by intraocular silicone oil.