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.

[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.

[Intravitreal ranibizumab for management of choroidal neovascularization secondary to angioid streaks: a case report]. / Traitement par injection intravitréenne de ranibizumab de néovaisseaux choroïdiens compliquant des stries angioïdes : à propos d'un cas.

Angioid streaks are biomicroscopically observable manifestations that frequently lead to choroidal neovascularization. Traditional treatments used to include laser photocoagulation or photodynamic therapy. Over the past few years, anti-VEGF therapies have been used as an alternative treatment. The case of a 54-year-old patient who received anti-VEGF therapy (ranibizumab) for the treatment of choroidal neovascularization secondary to angioid streaks is reported. The patient received two injections that led to complete resolution of intraretinal fluid and reduction in lesion size. After 1 year of follow-up, the patient has presented no recurrence. This case illustrates the efficacy of intravitreal anti-VEGF therapy for choroidal neovascularization in angioid streaks. Further prospective studies on a larger number of patients should help establish the best treatment and follow-up strategies.

[Has surgery of the vitreous evolved?]. / La chirurgie du vitré évolue-t-elle ?

Three ports pars plana vitrectomy has been described 50 years ago. From indications to salvage the peripheral retina function, it has progressively shifted towards functional indications in macular pathologies, trying initially to stabilize and now to improve visual acuity. This has been achieved by improvement, not only of surgical material but also of microscopes, intraoperative rools such as perfluorocarbone liquids and more recently the use of vital dyes.

[Intravitreal bevacizumab treatment for choroidal neovascularization in Best's disease]. / Traitement par injection intravitréenne de bevacizumab de néovaisseaux choroïdiens compliquant une maladie de Best.

Best's disease is an autosomal-dominant macular dystrophy, which might lead to choroidal neovascularization. The case of a 9-year-old boy followed up for a Best's disease is hereby reported. The boy was referred to our service department for a decrease in visual acuity in his right eye. Ophthalmoscopic examination revealed a foveolar vitelliform lesion, complicated by a choroidal neovascularization. The patient received a single intravitreal bevacizumab injection, which led to a complete resolution of intraretinal fluid and a significant reduction in neovascularization size. Visual acuity also improved. This case underlines the efficiency efficacy of intravitreal anti-VEGF therapy for choroidal neovascularization in Best's disease.

[Surgical management of sub-retinal haemorrhage secondary to polypoidal choroidal vasculopathy]. / Prise en charge chirurgicale des hémorragies sous-rétiniennes secondaires à une vasculopathie polypoïdale.

We report the case of a 34-year-old black woman with acute and severe unilateral loss of sight related to idiopathic polypoidal choroidal vasculopathy responsible for a sub macular haemorrhage (1/10 on the Monoyer scale). The patient underwent a pars plana vitrectomy associated with a sub retinal administration of tissue plasminogen activator (100 µg) and a pneumatic displacement by gas (C2F6) with facedown positioning for 5 days. There were no intraoperative complications and the clot was lysed and totally displaced from the macula. There was no recurrence of the disease and the retinal epithelium detachment decreased progressively. The final visual acuity was 7/10. This case report illustrates the capacity and efficacy of this surgical procedure in the management of sub macular haemorrhage related to polypoidal choroidal vasculopathy. It provides effective displacement of the clot, limiting retinal damage induced by sub macular haemorrhage. Furthermore, it allows early treatment of the polypoidal aneurysm by laser or dynamic phototherapy and increases final visual acuity. Randomised studies are expected to determine the indication for this surgical procedure in the management of polypoidal choroidal vasculopathy and the possible association of laser, dynamic phototherapy, or anti-VEGF treatments.

TPA-assisted vitrectomy for proliferative diabetic retinopathy: results of a double-masked, multicenter trial.

OBJECTIVE: Some complications of vitrectomy are related to adherence of the vitreous body to the retina. We studied whether these complications could be decreased by injecting a proteolytic enzyme, tissue plasminogen activator (TPA), at the beginning of surgery to aid separation of the vitreous from the retina. METHODS: Fifty-six patients receiving surgery for complications of proliferative diabetic retinopathy were divided into two groups in this prospective, randomized, double-blind study. Group I patients received 25 microg of intravitreal TPA in buffered salt solution (BSS) 15 minutes before vitrectomy. Group II received BSS alone. Postoperative follow-up lasted up to 3 months. The major criteria for comparison were the number of perioperative iatrogenic tears, the gain in visual acuity, and the reattachment rate of tractional retinal detachments. RESULTS: No difference was found between the two groups for the principal indicators or for complications. CONCLUSION: In proliferative diabetic retinopathy, the use of 25 microg of TPA by intravitreal injection 15 minutes before vitrectomy does not improve the results. No specific complications of the method were noted. The failure can be attributed to a too-short delay between TPA injection and beginning of surgery, an insufficient dose, or an insufficient quantity of plasminogen in the vitreous at the beginning of the intervention.

[Retinal detachment following YAG laser section of vitreous strands. Apropos of 3 cases]. / Décollement de rétine après tentative de section de brides vitréennes au laser YAG. A propos de 3 cas.

PURPOSE: Retinal detachment after Nd: YAG laser vitreolysis is rarely reported. The pathogenic role of Nd: YAG laser is analyzed from 3 cases of severe retinal detachment. METHODS: Three men aged (40 to 59 years old) had one or more risk factors for retinal detachment: myopia, complicated cataract surgery, personal or family history of retinal detachment. Nd: YAG laser treatment onto vitreous strand was performed because of: retinal traction, repeated vitreous hemorrhage, anterior vitreous strand in a aphakic patient with cystoid macular edema. Within six weeks following Nd: YAG laser vitreolysis, severe retinal detachment with several tears occurred, complicated with proliferative vitreoretinopathy in two patients, and with choroidal hemorrhage in one. In two cases, several surgical procedures with silicon oil were required and visual acuity remained under 20/1000. In the last case retinal reattachment was obtained with scleral buckling and cryopexy, the patient recovered a visual acuity of 20/100 with a macular pucker. DISCUSSION: Retinal detachment occurred shortly after laser YAG vitreolysis. We assumed Nd: YAG laser was possibly responsible and investigated the possible mechanisms: direct retinal tear, vitreous strand traction, side effect of intraocular shock wave. CONCLUSION: Nd: YAG laser vitreolysis seems to be able to cause retinal detachment. Its use is therefore not recommended, particularly in patients at risk, especially since the efficacy of this treatment has not been proved.

[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.

[Prediction of functional recovery after surgery of macular epiretinal membranes. Value of interferometry using Lotmar's apparatus]. / Prédiction de la récupération fonctionnelle après chirurgie des membranes épi-rétiniennes maculaires. Intérêt de l'interférométrie au visomètre de Lotmar.

BACKGROUND: The predictability of the measurement of the macular function by white light interferometry was evaluated in a group of patients whose epiretinal membranes had been surgically removed. METHOD: Fifteen patients presenting either primitive or secondary epiretinal membranes were included. We used the apparatus described by W. Lotmar. The main evaluation criteria was the best corrected visual acuity (VA) chosen between the third month and the sixth month examinations. RESULTS: Preoperatively the mean visual acuity was 0.227 +/- 0.105. The mean final visual acuity was 0.507 +/- 0.198. The final visual acuity was predicted within an 0.1 interval in ten cases (67%). In two cases the predicted visual acuity was identical to the pre-operative VA and the final results confirmed the test. No improvement occurred. CONCLUSION: The Lotmar visometer is statistically predictive of the visual outcome after epi-retinal membranes surgery.

[Failures of the surgical treatment of rhegmatogenous retinal detachment]. / Echecs du traitement chirurgical des décollements de rétine rhegmatogènes.

The surgical treatment of rhegmatogenous retinal detachment, has considerably improved. But there are still a lot of failures, at least after the first surgical procedure. Out of a group of 320 retinal detachments, a one stage surgical procedure allowed the retina to reattach in 84% of cases. Out of the 51 failures, we defined 2 subgroups: the early recurrences were mainly caused by undiagnosed breaks or insufficient scleral buckling, and the delayed recurrences by a vitreo-retinal proliferation or a new tear. Though a second operation increased the success rate to 97%, it is certainly desirable to lower the failure rate of the first surgical procedure.

[Ultrasonic treatment of hypertonia caused by intraocular silicone oil]. / Traitement par ultra-sons des hypertonies provoquées par l'huile de silicone intra-oculaire.

The authors treated 53 patients with uncontrolled glaucoma in silicone oil filled eyes with high intensity focused ultrasound. The silicone oil filled eyes present unusually difficult problems in glaucoma management, since the silicone oil rapidly obstructs filtration openings, and laser techniques have not been effective. The mean pretreatment pressure was 34.2 mmHg. The patients were followed for a mean of 17 months. Seventy-five per cent of ultrasound treated eyes had successful reduction of intraocular pressure to below 20 mmHg with or without concomitant medical treatment at two years after treatment. The complication rate was low in this group of eyes. Five eyes developed hypotonia and three eyes had full thickness scleral perforations but were effectively controlled and developed no other complications during two years of follow-up. This technique appears more effective than cyclo-destructive techniques alone.

[Is vitrectomy cataractogenic? Study of changes of the crystalline lens after surgery of retinal detachment]. / La vitrectomie est-elle cataractogène? Etude des modifications du cristallin après chirurgie du décollement de la rétine.

In order to assess the relationships between vitrectomy and postoperative crystalline lens changes we reviewed the records of 298 selected cases of operated retinal detachments in phakic eyes. We compared two groups: 155 eyes were operated with cryotherapy, vitrectomy and gas injection. 143 eyes received cryotherapy and retro-hyaloid fluid-gas exchange. Follow-up of at least 12 months and detailed description of the lens were available in 90 cases and 82 cases of the two groups respectively. Postoperative lens changes were as follows: nuclear sclerosis occurred in 63% of the vitrectomised eyes, mild in 14%, moderate in 16%, severe in 32%. In contrast, nuclear sclerosis occurred in only 4% of the non vitrectomised eyes, all these cases were noted as moderate. Posterior subcapsular opacities occurred in 4.5% of the vitrectomised eyes versus 2.4% of the non vitrectomised eyes. Nuclear sclerotic changes were correlated with vitrectomy and longer follow-up. Posterior subcapsular cataract was correlated with vitrectomy and larger intraocular gas bubble.

[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.

[Liquid perfluorocarbon in treatment of giant tears]. / Flüssiges Perfluorocarbon bei der Behandlung von Riesenrissen.

In 20 cases of giant tears with considerable proliferative changes, vitreoretinal silicone-oil-surgery was performed. With liquid perfluorocarbon, the involuted retina could easily be fixed during the operation in its former position without difficulties, before silicone oil as a permanent tamponade was used. The good results prove that more invasive manipulations, which were formerly necessary, become superfluous using this method.

Five-year results of the first 159 consecutive phakic chronic open-angle glaucomas treated by argon laser trabeculoplasty.

159 phakic eyes with chronic open-angle glaucoma were treated by argon laser trabeculoplasty and followed for 5 years. According to our criteria of failure, 31 eyes were failures at 1 year (19%), 47 eyes at 2 years (30%), 66 eyes at 3 years (41%), 77 eyes at 4 years (48%) and 82 eyes at 5 years (52%). In the 77 eyes still controlled at 5 years, the intraocular pressure drop was 6.57 mm Hg and the initial medical treatment could be tapered or stopped in only 33 of the cases (43%). In the 82 failures, there was a greater percentage requiring surgery for pressure control during the first year after laser treatment: 16 trabeculectomies in 31 failures (52%). The initial mean intraocular pressures of 7 failures needing surgery during the first 2 months (27.22 mm Hg) and of the 27 failures needing surgery during the 5 year follow-up (24.41 mm Hg) were higher than the initial mean intraocular pressure of the 77 successful cases (22.67 mm Hg). In the 159 eyes followed for 5 years, 19% (31 eyes) to 6% (5 eyes) new failure cases per year were encountered and the initial good results obtained by argon laser trabeculoplasty persisted for about 5 years in half of the cases.

[Preventive treatment of retinal detachment of the contralateral eye. Results of 5 years follow-up of 109 eyes]. / Traitement prophylactique du décollement de rétine de l'oeil adelphe. Résultats avec un recul de cinq ans, sur 109 yeux.

In 1987, we presented a study of 141 eyes treated prophylactically following retinal detachment in the fellow eye. A hundred and nine of these patients are reviewed with a minimum follow-up of five years. Only the evolution was studied, whether a peripheral retinal lesion was present or not at the time of prophylactic treatment. The examiner noted if new lesions had occurred, or if lesions present at the time of the first examination had developed: lattice degeneration or snail track developing into a retinal tear, hole or tear causing a retinal detachment, contained or not by laser treatment. Our study contained sixty two myopes. Fifty eyes had visible, dangerous lesions, and fifty nine a normal retina. Forty five circular barrages with four anterior radial rows returning to the ora serrata were performed, and sixty four barrages with tight anterior grids and a localised barrage of visible lesions. The results were judged on one criterion only: retinal detachment requiring emergency surgery. Only one retinal detachment occurred behind the barrage, caused by proliferative vitreoretinopathy due to multiple tears, and surgical results were good. Eight tears appeared in front of the barrage, five of these in healthy retina. Two very posterior tears behind the barrage were blocked with no problem by laser treatment. Four localised detachments occurred in front of the barrage, three of these without anterior grid treatment. The advantage of this is undeniable since out of sixty three cases treated in this way, only three tears were seen to be blocked by the laser shots, and one anterior localised detachment where the anterior grid was insufficient.(ABSTRACT TRUNCATED AT 250 WORDS)