[Treatment of age-related macular degeneration with intravitreous injections of bevacizumab (Avastin): short-term results]. / Traitement de la dégénérescence maculaire liée à l'âge par injections intravitréennes de bevacizumab (Avastin): résultats à court-terme.

PURPOSE: To analyse short term visual outcomes and macular morphologic changes associated with intravitreal injection of bevacizumab (Avastin) therapy for subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (AMD) METHOD: Retrospective study of 59 eyes. Each included eye received 3 intravitreal injections of 1.25 mg bevacizumab at 4 to 6-week intervals. Mean follow-up was 5.5 months (range 3 to 9). Best-corrected visual acuity, ophthalmoscopic examination, optic coherence tomography and fluorescein or green indocyanin angiography were performed before and routinely after the treatment. RESULTS: A total of 160 injections were performed with a mean value of 2.7 (1-6) per eye. Visual acuity improved at least two lines in 17% (10 eyes), worsened at least two lines in 14% (8 eyes) and was stabilized in 69% (41 eyes). Among that last group of 41 eyes, a significative reduction of macular thickness was observed in more than 39% (12 eyes) and a subjective improvement with less metamorphopsia and better visual comfort was noticed in 24% (10 eyes). No intraocular or systemic adverse effects were observed except a self-limited iritis in two cases. CONCLUSION: Intravitreal bevacizumab therapy resulted in visual and morphologic improvements in a significant number of cases of advanced AMD with CNV. Randomized studies and longer follow-up are needed to confirm these preliminary results.

[Ocular manifestations of cancer]. / Manifestations oculaires des cancers.

Cancer may affect the eye and orbit as a direct result of metastatic neoplastic infiltration, compression, or circulating antibodies involving paraneoplastic retinal degeneration. A metastatic tumor to the uvea is the most common form of an intraocular metastatic process. The choroid is the most common site for uveal metastasis; metastases to the ciliary body, iris, retina, optic disk, and vitreous are rare. Approximately one-third of patients have no history of primary cancer at the time of ocular diagnosis. Breast and lung carcinomas for women and lung and gastrointestinal carcinomas for men most commonly metastasize to the eye and orbit. The short-term prognosis for vision is usually good after an individualized therapeutic approach (chemotherapy, hormonal therapy, external beam radiotherapy, or plaque radiotherapy), but the systemic prognosis is poor. The visual paraneoplastic syndromes encompass several distinct clinical and pathological entities including carcinoma-associated retinopathy (CAR), melanoma-associated retinopathy (MAR), and bilateral diffuse melanocytic uveal proliferation (BDUMP). The CAR syndrome affects photoreceptors, MAR is thought to affect bipolar cell function, and BDUMP targets the uveal tract. Identification of circulating antibodies against retinal proteins (recovering, 23-kDa retinal protein; 46-kDa and 60-kDa retinal proteins) serves to recognize the paraneoplastic nature of the patient's symptoms, which frequently develop before the cancer is diagnosed. Anecdotal therapeutic responses are described after systemic steroids, immunoglobulin injection, and plasmapheresis. Recognition of their visual symptoms and ocular findings should alert the ophthalmologist to the possibility of cancer and systemic evaluation should be pursued.

[Advantages of digital indocyanine green angiography for diagnosing choroidal tumors]. / Intérêt de l'angiographie numérisée au vert d'indocyanine dans le diagnostic des tumeurs choroïdiennes.

Indocyanine green angiography (ICG) is a well-known ancillary test for evaluation of choroidal tumors. The authors review the different images seen in choroidal nevus, melanoma, metastasis, hemangioma, osteoma, and vortex vein varix. ICG appears to be useful for the diagnosis of non pigmented choroidal tumors. In addition, ICG provides good information on the limits of pigmented tumors, particularly for the follow-up of a growing tumor and the choice of treatment.

Multiple arterial ectasias in patients with sarcoidosis and uveitis.

PURPOSE: To describe and evaluate the cause of a clinical entity characterized by bilateral intraocular inflammation, multiple arterial ectasias including beading, macroaneurysms, comma-like ectasias and kinking, with vasculitis, staining of the optic disk and multiple peripheral round punched-out hypopigmented chorioretinal scars in elderly patients. The formation and the course of the arterial ectasias is analyzed. METHODS: Seven patients with this syndrome were evaluated by clinical examination, fluorescein angiography, and systemic investigations. RESULTS: Three of the seven patients had a biopsy characteristic of sarcoidosis, two others showed positive bronchoalveolar lavage, as well as other analyses and tests suggesting sarcoidosis, and two showed other findings suggestive of sarcoidosis. The patients were all over 60 years of age and had arterial hypertension. In two patients, an arterial ectasia developed at the site of previous focal inflammation. The macroaneurysms either remained unchanged, became comma-like ectasias, arterial kinks, or completely vanished. CONCLUSION: Elderly patients with multiple arterial ectasias, uveitis, disk staining, and peripheral chorioretinitis should be thoroughly investigated for sarcoidosis. We suggest that sarcoidosis may cause some degree of arteritis, which may weaken the arterial wall, with resulting ectasia. Arterial hypertension may play a role in the formation of the ectasias by increasing the pressure on the arterial wall weakened by inflammation.

Polypoidal choroidal vasculopathy in Caucasians.

PURPOSE: To study the prevalence of polypoidal choroidal vasculopathy (PCV) in Caucasian patients with occult choroidal neovascularization (CNV); to study the clinical spectrum of PCV in Caucasians and the outcome after laser photocoagulation of such lesions. METHODS: (1) A consecutive series of 374 eyes of Caucasian patients at least 58 years old, presenting occult CNV, presumed to have age-related macular degeneration (AMD) on fluorescein angiography (FA) were further characterized by indocyanine green angiography (ICGA) to determine the frequency of PCV. (2) The funduscopic, FA and ICGA findings in a cohort of 36 Caucasian patients with PCV were analyzed. (3) The outcome after laser photocoagulation was studied in 14 PCV eyes with a minimum follow-up of 6 months. RESULTS: (1) Fourteen of 374 eyes (4%) presenting occult CNV in patients at least 58 years old were diagnosed as PCV by means of ICG-A. (2) A polypoidal lesion was found in the macula in 22 of 45 PCV eyes, in the peripapillary area in 16 of 45, under the temporal vascular arcade in 6 of 45 and in the midperiphery in 6 of 45. Large or soft drusen were observed in 15 of 45 eyes with PCV. (3) Regression of fundus signs without persisting polyps 6 months after laser photocoagulation was obtained in 5 of 5 treated peripapillary lesions but in only 5 of 9 treated macular or arcade lesions. CONCLUSION: Polypoidal choroidal vasculopathy is not rare in Caucasian patients presenting with occult choroidal neovascularization. The fundus abnormalities seen in such eyes overlap with the typical manifestations of AMD. Whereas the prognosis after photocoagulation of peripapillary polypoidal lesions appears to be relatively good, it is more guarded for macular or arcade lesions.

Bilateral granulomatous panuveitis as initial presentation of diffuse systemic T cell lymphoma.

A high-grade diffuse T cell lymphoma, initially simulating bilateral panuveitis, was diagnosed by analysis of a vitreous biopsy specimen and a breast tumor in a 57-year-old woman. It responded favorably to aggressive chemotherapy before it relapsed in leukemic transformation. This case emphasizes the misleading initial symptoms of primary intraocular lymphoma and the role of immunophenotyping in the diagnosis and classification of lymphoproliferative ocular disorders. The presentation and management of uveal lymphoid neoplasia are discussed.

[Radiotherapy treatment of subfoveal retinal neovascularization related to age]. / Traitement par radiothérapie des néo-vaisseaux sous-rétiniens rétrofovéolaires liés à l'âge.

Thirty-three patients who underwent low dose of radiation therapy for subfoveal choroidal membranes were studied after a mean follow-up of 16 months. The evaluated parameters were the visual outcome and the choroidal neovascularization evolution. In this study, the efficacy of low-dose radiation delivered to the macular region as an alternative treatment in subfoveal membrane was limited.

[Proliferative diabetic retinopathy: laser photocoagulation treatment]. / Rétinopathie diabétique proliférante: traitement par photocoagulations au laser.

Laser panretinal photocoagulation has proven its efficacy in controlling proliferative diabetic retinopathy. It is unclear exactly how photocoagulation works: several mechanisms are evoked, involving the pigment epithelium, the photoreceptors and the retinal microvascularization. Indications for treatment and the way of carrying it out are reviewed. Possible complications related with photocoagulation can occur. Some advanced or complicated forms of proliferative diabetic retinopathy need alternative treatments like cryotherapy or vitreoretinal surgery.

[Occlusion of the central retinal vein in young adults: risk factors and visual prognosis]. / Occlusion de la veine centrale de la rétine chez le jeune adulte: facteurs de risque et pronostic visuel.

Retrospective study of 15 cases of central retinal vein occlusion in young patients. A research for risk factors was performed. 4 patients had a systemic disease, and 6 had thrombophilic hematological conditions like blood hyperviscosity and increased platelet aggregation. No inflammatory disease was found. The visual prognosis was good in 7 out of 12 patients with a follow-up of more than 3 months. Chronic macular edema and neovascular glaucoma were responsible for the bad visual prognosis in 5 cases.

Fundus changes in membranoproliferative glomerulonephritis type II. A fluorescein angiographic study of 23 patients.

A total of 23 patients aged between 11 and 64 years who had biopsy-proven membranoproliferative glomerulonephritis type II (dense deposit disease) were studied using fluorescein angiography of the retina. With the exception of two adolescents, all patients exhibited small subretinal nodules that were similar to basal laminar drusen. Subjects with a long history of renal disease displayed more numerous and larger nodules as well as atrophic changes. Four subjects presented with subretinal neovascular membranes.

[Syphilitic uveitis. Apropos of 2 cases]. / Uvéite syphilitique. A propos de deux cas.

Report of two cases of syphilitic uveitis which presented vasculitis, papillitis, cystoid macular edema and large disturbance of the pigment epithelium. The superior value of the FTA-Abs test and of the cerebrospinal fluid analysis in the diagnosis of the disease is discussed. Treatment with high doses of Penicillin G for 10 to 15 days is recommended.