[Intravitreal injections: Guidelines, methods and medicolegal issues]. / Injections intravitréennes : principes, techniques et aspects médicolégaux.

Intravitreal injection (IVI) of a drug allows for immediate intraocular concentrations of active ingredients higher than those obtained by intravenous injection while reducing the risk of systemic side effects. Today, IVI's play a central role in the treatment of many vitreoretinal diseases. With the aging of the population and the advent of vascular endothelial growth factor (VEGF) antagonists, their indications have increased exponentially, creating structural, organizational and economic difficulties. IVI is now one of the most widely performed medical procedures in industrialized countries, and its indications are expected to expand further in the near future with the development of new molecules. Although the overall safety of this practice is proven, an IVI exposes the patient to a 0.05 % risk of endophthalmitis, the consequences of which are often dramatic. This article details the current recommendations, in particular regarding asepsis and antisepsis, and proposes a typical sequence for performing an IVI.

[Impact of the French 2020 COVID-19 lockdown on the treatment and follow-up of patients with exudative age-related macular degeneration]. / Impact du confinement français en 2020 sur la prise en charge des patients atteints de dégénérescence maculaire liée à l'âge exsudative.

PURPOSE: To assess the impact of the measures taken during the lockdown period from March 17 to May 11, 2020 on the management of patients with exudative age related macular degeneration treated by intravitreal anti-VEGF injections at the University Hospital of Tours. METHODS: In this retrospective study, patients were included after analysis of the computerized medical records of patients with age related macular degeneration. Those who were treated for exudative age related macular degeneration who received at least 1 intravitreal injection in the 12 months prior and at least one consultation in the 6 months prior to the lockdown period, were included. The initial and final mean visual acuity were compared with a 5 letter non-inferiority margin. A subgroup analysis was performed according to outcomes. The visual acuities immediately after this period were also recorded. RESULTS: In all, 595 eyes of 493 patients were included. The mean initial visual acuity was 59.6 letters, vs. 58.5 for the final visual acuity, i.e. a difference of -1.13 letters with a lower limit of the confidence interval of less than 5. The visual acuity on release from lockdown was comparable to the other 2 measurements. Initial visual acuity and the number of missed treatments were the main factors associated with functional loss. CONCLUSION: Patients' visual acuity during the lockdown period was able to be maintained despite the restrictive measures and limitation of care access in France. The most common cause of substantial visual decline was missed intravitreal injections.

Evaluation of YouTube videos as a patient information source on intravitreal injection procedures.

PURPOSE: To evaluate the content, reception and quality of YouTube videos on intravitreal injection (IVI) procedures as an educational resource for patients. METHODS: Our study was a retrospective, cross-sectional, register-based study. The terms "intravitreal injection," "intravitreal injection treatment," "eye injection," "eye injection treatment," "dexamethasone intraocular injection," "anti-VEGF injection," "Ozurdex®," "Lucentis®," and "Eylea®" were searched on YouTube. Video duration, total views, number of likes, number of dislikes, and number of comments were recorded. Quality and reliability of video content was assessed using the DISCERN questionnaire, Journal of the American Medical Association (JAMA) score, and the Global Quality Score (GQS). The video power index (VPI) was used to determine the popularity of the videos. RESULTS: One hundred eleven videos were included in the study. The mean duration was 4.30minutes, and the mean number of views was 27,415.90. The mean DISCERN, JAMA, and GQS scores were 45.39±9.7, 1.76±0.49, and 3.60±0.84 respectively. The mean VPI was 12.16±35.56 (0-277.80). Video publishers were as follows: 31 (27.9%) private hospital YouTube channels, 17 (15.3%) ophthalmologists, 45 (40.5%) health-related YouTube channels, 18 (16.2%) "other channels." Seventy-two (64.9%) of the main narrators of the videos were ophthalmologists. The DISCERN, GQS and JAMA scores were correlated (P = 0.001). There was no correlation between the VPI scores and the DISCERN, JAMA and GQS scores (P = 0.05). CONCLUSION: This study showed that YouTube videos on IVIs contain moderately useful information for patients. YouTube videos may be helpful for patients seeking information about IVIs, but physicians must be careful to correct any misunderstandings.

"The effect of two different intravitreal injection techniques on frequency of vitreous reflux and on treatment response in neovascular AMD patients".

PURPOSE: To determine the effect of two distinct intravitreal injection (IVI) techniques on the frequency of vitreous reflux (VR) and on treatment response at cumulative dosages in neovascular age-related macular degeneration (nAMD) patients. PATIENTS AND METHODS: Ninety-three eyes of 93 nAMD patients were included in the study. IVI was performed in 47 eyes using the straight technique (ST) and 46 eyes with the tunneled technique (TT). Patients received three loading doses of intravitreal bevacizumab, and substantial VR was noted for each IVI. Central (CMT), 1mm (MT1), and 3mm (MT3) macular thicknesses were measured before and after treatment. VR frequency and treatment response were compared in both groups, and correlation analysis was performed. RESULTS: Post-treatment VR was seen in 91 of 141 IVI with the ST and 33 of 138 IVI with the TT. The decrease in CMT, MT1, and MT3 after treatment with the ST was 121.4±92.5µm, 65.3±50.6µm, 28.8±30.8µm, respectively, and with the TT was 114.0±97.5µm, 67.8±72.6µm, and 27.1±31.4µm, respectively. The ST substantially increased the rate of VR compared to the TT (P<0.001), whereas the decrease in CMT, MT1, and MT3 did not vary significantly (P>0.05). There was no correlation between VR rate and decreases in CMT, MT1, or MT3 (P>0.05). CONCLUSIONS: According to our findings, the ST resulted in a higher frequency of VR than the TT, but VR did not affect the treatment response, despite multiple doses. Complication rates were negligible with both approaches. As a result, it appears that practitioners may use either IVI approach.

[Intravitreal clindamycin injection in toxoplasma retinochoroiditis: About 9 cases in the ophthalmology department of the CHU de Bordeaux]. / Injection intravitréenne de clindamycine dans le traitement des rétinochoroïdites toxoplasmiques : à propos de 9 cas dans le service d'ophtalmologie du CHU de Bordeaux.

INTRODUCTION: Toxoplasma retinochoroiditis (TRC) is the main cause of posterior uveitis in immunocompetent patients. Several studies have shown safety and efficacy of treatment with intravitreal clindamycin injection in patients with contraindications, inadequate response or side effects with classic oral therapy. The goal of this study is to describe anatomic and functional results of local treatment with intravitreal clindamycin injection. MATERIALS AND METHODS: We performed an observational, retrospective, single-center study in the ophthalmology service of Bordeaux university medical center between December 2017 and January 2020 on management of toxoplasma retinochoroiditis by intravitreal clindamycin injection. We analyzed the efficacy of this treatment on improvement in visual acuity, decrease in size of the retinal lesion and decrease in macular thickness. RESULTS: A total of 10 eyes of 9 patients were injected. Only a single injection was required in 9 of the 10 cases. Injections demonstrated improvement in the 3 study criteria; visual acuity went from a mean of 1 LogMAR (1.07±0.77) pre-injection to 0.4 LogMAR (0.43±0.53) at 6 months, lesion size decreased by 51%, and macular thickness decreased by 78µm over the follow-up period. CONCLUSION: Intravitreal clindamycin injections are safe and effective for the treatment of TRC. They offer an alternative in patients with allergies, side effects or inadequate response to classic oral therapy.

[Intravitreal viscoelastic injection for management of combined choroidal and retinal detachments]. / Injection intra-vitréenne de produit viscoélastique pour la gestion des décollements choroïdiens associés aux décollements de rétines.

INTRODUCTION: Combined retinal detachment and choroidal detachment (RDCD) is a serious type of retinal detachment occurring mainly in high myopes, which poses many pre-, intra- and postoperative difficulties that can affect the visual prognosis. MATERIAL AND METHODS: Personal technique used in 8 patients with RDCD, consisting of intravitreal injection (IVI) of a viscoelastic (VE) device 2 to 3 days prior to vitrectomy. RESULTS: Reattachment of the choroid in all patients, with return to normal IOP, allowing vitrectomy to be performed under optimal conditions. DISCUSSION: RDCD often occurs in high myopia, especially in the case of an associated giant tear, the mechanism of which involves severe hypotony, resulting in a vicious cycle including development of the choroidal detachment (CD), partial retinal reattachment, normalization of the IOP, redetachment of the retina, and once again, hypotony. Preoperative viscoelastic IVI can break this vicious cycle and reattach the choroid, often within 24 to 48hours. This thus facilitates RD surgery without the intra- and postoperative technical difficulty of managing the CD. CONCLUSION: Viscoelastic IVI is a simple, safe, inexpensive and reproducible technique for the treatment of CD associated with RD in order to prepare for RD surgery under the usual conditions without a CD.

[Neovascular recurrences in 42 treatment-naive eyes with neovascular age-related macular degeneration (AMD) followed for over 2 years]. / Étude des récidives exsudatives chez 42 yeux naïfs atteints de dégénérescence maculaire liée à l'âge suivis plus de 2 ans.

INTRODUCTION: The objective of this study was to analyze the reproducibility or variability of the time period to exudative recurrences in patients who were treated with intravitreal injections (IVT) of anti-VEGF (ranibizumab, aflibercept) for exudative age-related macular degeneration (AMD). The data studied included the number of recurrences per year, the time between the last IVT and the recurrence, fluctuation over time in the same patient, and changes in the therapeutic management of these exudative recurrences with regard to repeat induction therapy of three IVT, changes in monitoring protocols, and switches in anti-VEGF molecules. MATERIALS AND METHODS: We conducted a retrospective, single center, "real-life" study at the Nantes University Hospital, including 33 patients (42 eyes) between March 2012 and March 2017. These were IVT-naive patients, in whom anti-VEGF IVT treatment was initiated for management of exudative AMD, with a follow-up period of at least two consecutive years. The main outcome was the fluctuation in recurrences times for the same patient. RESULTS: Of the 33 patients included, 9 had bilateral involvement, for a total of 42 eyes. Twenty were women (60.6 %), the median age at inclusion was 78.5 years with a follow-up period of 3.7 years. The average time to recurrence was 11.6 weeks after the last IVT. The first recurrence occurred within 9.8 weeks after the last IVT. 12.3% of the eyes had consisent recurrence times, with fluctuations of less than 2 weeks between the various relapses over the two years of follow-up. a total of 7.1% of the eyes had no exudative recurrences during follow-up. The first exudative recurrence occurred at a mean of 38.2 weeks after diagnosis of the disease, or 37.2 weeks after the first IVT. 14.3% of the recurrences led to the administration of a repeat induction of three intravitreal anti-VEGF injections, 8.6% led to a change in anti-VEGF molecule, and 7.1% to a modification of the treatment protocol. DISCUSSION: The goal of this study was to analyze the variability of the time to exudative recurrence in patients treated with anti-VEGF IVT in the context of exudative AMD, because, since the advent of anti-VEGF IVT in 2007, few data have been available on long-term follow-up and fluctuations in recurrence times in patients who will receive treatment for several years. CONCLUSION: Recurrences times are not reproducible over follow-up, particularly in patients experience their first exudative recurrence beyond 8 weeks and in patients with multiple exudative recurrences.

[Contribution of respiratory relaxation techniques during intravitreal injections: A pilot study]. / Apport des techniques de relaxation respiratoire au cours des injections intravitréennes : étude pilote.

PURPOSE: To study the effects of breathing techniques for anxiety, perceived pain, and patient satisfaction while receiving intravitreal injections. METHOD: This prospective, randomized clinical study included patients admitted for intravitreal anti-VEGF injections. They were randomized into two groups: a relaxation group who listened to a prerecorded relaxation breathing session before and during the injection, and a control group who received the injection without a relaxation session. Statistical analysis was then performed to assess the factors influencing satisfaction, anxiety, and perceived pain. RESULTS: We included one-hundred four patients in total: 52 in the relaxation group versus 52 in the control group. The relaxation group had a greater decrease in anxiety than the control group (P=0.03) but similar levels of pain (P=0.86). In total, 80.76% of patients in the relaxation group expressed the wish to have a relaxation session during their next injection. Multivariate analysis showed that the patient's usual level of stress as well as the relaxation session affected the level of anxiety experienced before the injection. CONCLUSION: Relaxation techniques before and during intravitreal injections decrease anxiety in patients without decreasing pain during IVT. Prerecorded relaxation breathing sessions are non-invasive, inexpensive, easy to set up, and reduce anxiety during intravitreal injections on an outpatient basis.

[Retinal vein occlusions treated by intravitreal bevacizumab injections at the Hospital of Instruction, Application and Reference of the Armed Forces of Yaoundé]. / Occlusions veineuses rétiniennes traitées par injections intra-vitréennes de bévacizumab à l'hôpital d'instruction, d'application et de référence des armées de Yaoundé.

OBJECTIVE: To assess the anatomical and functional results of intravitreal bevacizumab injections in retinal vein occlusions at the Hospital of Instruction, Application and Reference of the Armed Forces of Yaoundé. PATIENTS AND METHODS: A prospective and descriptive study was conducted from October 2016 to August 2017 at the Hospital of Instruction, Application and Reference of the Armed Forces of Yaoundé. All eyes with edematous or mixed retinal vein occlusion were treatment naive and received at least 3 intravitreal injections spaced at least 28 days apart of bevacizumab 25mg/ml at a dose of 0.05ml per session according to the strategy of 3 injections or "3 I". At least 3 months after the final injection, visual acuity and macular thickness, assessed by optical coherence tomography, were analyzed with the IBM-SPSS 22 software. The Student's test was used to compare means, with a significance P<5%. RESULTS: We included nineteen eyes of 18 patients with a mean age of 62.83±9.57 years. The male to female sex ratio was 0.8. Branch vein occlusion was predominant in 14 (73.68%) eyes. The edematous type was noted in 17 (89.5%) eyes. Serous retinal detachment was present in 6 (31.6%) eyes. The mean number of injections was 4.2±1.2. The mean baseline visual acuity changed from +0.9 Log MAR (40 ETDRS) to +0.6 Log MAR (55 ETDRS) at 6 months, while the mean macular thickness went from 550.16±180µm to 338.58±127µm, with statistically significant differences. CONCLUSION: Intravitreal bevacizumab injections proved to be effective in the management of edematous retinal vein occlusions in our practice setting despite the lack of market authorization for this indication.

[Evaluation of intravitreal injection practice patterns in Cotonou]. / Évaluation de la pratique de l'injection intravitréenne à Cotonou.

INTRODUCTION: Intravitreal injections of medication are designed to obtain a high concentration in the posterior segment. We conducted a retrospective study of our practice of intravitreal injections to assess safety of the technique and short- and medium-term tolerability, and to analyze indications and the complications. PATIENTS AND METHODS: This analytic retrospective study focused on consecutive patients treated with intravitreal injections for the period of January 2015 to June 2016 in the "Lumière" ohthalmology clinic in Cotonou, with incidents or accidents during the injection procedure as a measure of safety. Included were all patients undergoing one or more intravitreal injections regardless of the type of product injected, who had undergone a complete ophthalmologic work-up prior to injection and who had been followed at one week (W1) and 1 month (M1) after treatment. RESULTS: During the study period, we safely performed 124 intravitreal injections on 49 patients. The indications were diabetic macular edema in 53.06% and macular edema due to vein occlusions in 26.53%. The main complication observed was ocular hypertension in 60%, mainly related to triamcinolone injection. In 51.02%, the drug used was Ranibizumab, followed by Bevacizumab in 28.54% and Triamcinolone in 20.40%. DISCUSSION: The main goal of intravitreal injection is to achieve instantly effective concentrations in the center of the globe. Intravitreal injection is a safe, feasible practice in our context. The male predominance observed in our series is explained by the low socio-economic status of women in our context as well as the economically difficult accessibility of important drugs such as anti-VEGF. Significant improvements in D7 and D30 visual acuity in our patients highlights the beneficial effects of the presence of the active molecule in the vitreous cavity for these indications. CONCLUSION: Intravitreal injection is a common practice in our context, which is being performed safely. The indications are many, and ocular hypertension is a significant complication. The difficulties in terms of supply and preservation of the main drugs used (anti-VEGF) remains to be resolved.

[Late and sustained intraocular pressure elevation related to intravitreal anti-VEGF injections: Cases requiring filtering surgery (French translation of the article)]. / Hypertonie intraoculaire retardée liée aux injections intra-vitréennes répétées d'anti-VEGF : des cas nécessitant une chirurgie filtrante.

We report cases of delayed, sustained elevated intraocular pressure (IOP) associated with repeated intravitreal anti-VEGF injections (IVI), which ultimately resulted in the need for filtering surgery. Two of the three cases demonstrated severe IOP elevation despite maximal medical treatment following unilateral IVI and required urgent filtering surgery. Optic nerve involvement was severe in all three cases. These intravitreal injections were performed for exudative age-related macular degeneration (AMD), and the patients did not show any sign of glaucoma or ocular hypertension prior to the initiation of treatment. Elevated IOP secondary to intravitreal steroids is a well-known side effect, as is immediate transient IOP elevation associated with anti-VEGF injection. Late, sustained IOP elevation after repeated injections of anti-VEGF, described approximately ten years ago, is often underestimated. Its incidence is estimated between 2.1% and 13% according to studies and increases with the number of IVI (cumulative effect). The pathophysiologic process is becoming increasingly understood, and several risk factors for this chronic IOP elevation have been identified. Most often, it is a moderate IOP elevation for which topical monotherapy is sufficient, or sometimes two, three or four medications or even selective laser trabeculoplasty (SLT). However, filtering surgery may rarely be required. Our findings illustrate a little-described phenomenon: a sudden, severe, late IOP elevation in response to anti-VEGF by an "overflow" effect, requiring urgent filtering surgery.

[A "fast track" to improve management of neovascular age related macular degeneration]. / Un « circuit court ¼ pour améliorer la prise en charge des patients atteints de dégénérescence maculaire liée à l'âge néovasculaire.

OBJECTIVE: To evaluate the role of a fast track for management of patients with neovascular age- related macular degeneration (nARMD) treated by intravitreal injection of anti-VEGF. PATIENTS: The records of 100 patients in the chronic maintenance phase of intravitreal anti-VEGF followed in the fast track and 63 patients followed in the standard protocol for at least 12 months were retrospectively analyzed. METHOD: Patients in the fast track underwent visual acuity (VA) testing by ETDRS, optical coherence tomography (OCT) and a physician assessment. The injection was performed the same day whenever possible. The primary endpoint to evaluate patient adherence was the time between the ideal date of visit or injection prescribed by the physician and the actual date of administration. RESULTS: The mean time between the ideal date of visit or injection prescribed by the physician and the actual date of administration was 4.1±7.5 days for the patients followed in the fast track and 5.6±18.7 days for the patients followed in the standard protocol. Mean VA remained stable for the patients followed in the fast track: 20/50 (20/800 to 20/20) at baseline vs. 20/50 (20/800 to 20/16) at the conclusion of follow-up. It dropped from 40/50 at baseline to 20/63 at the conclusion of follow-up for the patients followed in the standard protocol. CONCLUSION: In the context of a fast track, it was possible to improve the adherence of nARMD patients and maintain their VA gain or stabilization achieved after the induction phase.

[Treatment of macular hematoma complicating AMD by vitrectomy, subretinal r-TPA injection, intravitreal injection of bevacizumab combined with gas tamponade: Report of 4 cases]. / Traitement des hématomes maculaires compliquant la DMLA par vitrectomie, injection sous-rétinienne r-TPA, injection intravitréenne de bévacizumab associé à un tamponnement par gaz : à propos de 4 cas.

INTRODUCTION: The occurrence of a subretinal hematoma in age-related macular degeneration (AMD) is a serious complication that can impact the visual prognosis with a poor functional recovery. The management of this complication remains controversial. Several therapeutic methods have been described. We report the results of four patients treated with a protocol combining: vitrectomy, subretinal injection of r-TPA 0.025mg/0.3ml, intravitreal injection of 0.05ml of bevacizumab and retinal tamponade with 20% SF6 gas. PATIENTS AND METHODS: Our series consists of four patients with a submacular hematoma complicating AMD, included in succession between October 2013 and October 2014 and treated with the same treatment protocol and by the same surgeon. All patients underwent surgery within eight days after the onset of the macular hematoma. Patients with a consultation period longer than eight days did not undergo this treatment. Face down postoperative positioning was then carried out for seven days by the patients. RESULTS: We observed a shift in the macular hematoma in the four patients, which allowed the identification of secondary neovascularization responsible for the bleeding. The visual acuity improved in three patients from hand motion (HM) preoperatively to 2/10 at one month postoperatively. One patient maintained visual acuity 1/20 during the entire follow-up despite almost complete resorption of the subretinal hematoma. These visual acuities were stable at 6 months postoperatively. DISCUSSION: Macular subretinal hematoma can cause severe visual loss by several mechanisms. The blood accumulates between the neurosensory retina and the retinal pigment epithelium, which causes a toxic effect on the surrounding tissues, thus resulting in a loss of photoreceptors and cellular destruction in the pigment epithelium and choriocapillaris, evolving into a fibroglial scar. CONCLUSION: The therapeutic evaluation of this protocol in our series of four patients gives a favorable result. We observed an improvement in visual acuity in 3/4 of cases. This surgical technique appears to be effective in the treatment of this complication of AMD. However, a study on a larger scale is needed to confirm these results.

Follow-up after surgery for hemorrhagic AMD.

INTRODUCTION: The long-term functional results of macular hematoma (MH) surgery in exudative AMD are often limited. The goal of this study was to compare visual outcomes of monthly versus bimestrial follow-up in these patients. METHODS: Retrospective, interventional case series. Population : 21 eyes of 21 patients with SMH associated with exudative AMD. INCLUSION CRITERIA: first SMH associated with exudative AMD, with 1-year postoperative follow-up. EXCLUSION CRITERIA: blood located exclusively underneath the retinal pigment epithelium on OCT imaging, SMH due to different etiology, lost to follow-up, ≤5 postoperative visits and a different surgical protocol as described. Patients were divided into two groups according to the number of postoperative visits (number of intravitreal injections [IVT] combined with the number of consultations, only one visit was recorded when IVT and consultation occurred on the same day) during the 1-year postoperative follow-up: group 1 had ≥11 visits (n=8); group 2 had 6 to 10 visits (n=13). All eyes underwent vitrectomy with subretinal injection of recombinant tissue plasminogen activator, fluid-gas exchange and anti-VEGF intravitreal injection. The main outcome was change in best-corrected visual acuity (BCVA). RESULTS: Considering visual acuity (VA) change between 1-month and 1-year postoperative follow-up examinations, group 1 had statistically significant greater VA changes (logMAR -0.29±0.44 vs logMAR 0.42±0.73; P=0.016; P=0.016). In patients that had exudative recurrences (ER), group 1 received more anti-VEGF IVT than group 2 (P=0.045). CONCLUSION: Our results showed that monthly follow-up, between the IVT series, is highly recommended to preserve postoperative VA in patients undergoing surgery for SMH associated with AMD.

[Extemporaneous withdrawal with a mini-spike filter: A low infection risk technique for drawing up bevacizumab for intravitreal injection]. / Prélèvement extemporané du bévacizumab avec un mini-spike pour les injections intravitréennes : une technique de déconditionnement à risque infectieux minime.

PURPOSE: To describe a technique for extemporaneously drawing up bevacizumab for intravitreal injection (IVT) and report the rate of post-injection endophthtalmitis. PATIENTS AND METHODS: Retrospective monocentric analysis (January 2010-December 2014) of all IVT of bevacizumab drawn up with the following technique: in the operating room (class ISO 7) through a mini-spike with an integrated bacteria retentive air filter. The surgeon was wearing sterile gloves and a mask. The assisting nurse wore a mask. The bevacizumab vial was discarded at the end of each session. RESULTS: Six thousand two hundred and thirty-six bevacizumab injections were performed. One case of endophthalmitis was noted (0.016%). During the same period, 4 cases of endophthalmitis were found after IVT of other drugs (4/32,992; 0.012%. P=0.8). CONCLUSION: Intravitreal injection of bevacizumab after extemporaneous withdrawal through a mini-spike filter is a simple and safe technique. The risk of postoperative endophthalmitis is very low. This simple technique facilitates access to compounded bevacizumab.

[Ocular hypertension after intravitreal steroid injections: Clinical update as of 2015]. / Hypertonie oculaire après injections intra-vitréennes de corticoïdes, actualisation des connaissances en 2015.

Intravitreal injections are a therapeutic delivery method best suited to the treatment of retinal diseases. Recent years have been marked by the use of anti-VEGF agents as well as the arrival of sustained-release corticosteroid implants in France, replacing triamcinolone acetonide. A common complication of IVT steroids is secondary ocular hypertension (OHT) resulting from increased outflow resistance. This article summarizes current understanding. OHT induced by topical steroids has been described for 60 years. Intravitreal use also shows a temporary effect if the exposure is short, dose dependence, and varying incidence depending on the drug used. Sustained release formulations and discontinuing treatment have reduced the risk of induced OHT. Risk factors that induce OHT must be clearly identified prior to an injection. Most cases of OHT can be controlled medically, although differences exist between different drugs. In cases where it cannot be controlled, removal of the implant, selective laser trabeculoplasty, and filtration surgery can be discussed.

[Anti-VEGF therapy in the treatment of anterior segment neovascularization secondary to central retinal vein occlusion]. / Apport des anti-VEGF dans le traitement de la néovascularisation du segment antérieur compliquant les occlusions veineuses rétiniennes.

PURPOSE: To evaluate the benefit of anti-VEGF in the treatment of anterior segment neovascularization (ASNV), a severe complication of ischemic central retinal vein occlusion (CRVO). PATIENTS AND METHODS: This is a retrospective case series of consecutive patients with ASNV secondary to CRVO treated with anti-VEGF. Ophthalmic parameters were recorded for each visit: measurement of best visual acuity (VA), intraocular pressure (IOP), iris examination, gonioscopy and fundus examination, and as necessary, fluorescein angiography and optical coherence tomography. Minimum follow-up was 6 months. RESULTS: Nineteen patients (19 eyes) received intravitreal injections of anti-VEGF in association with panretinal photocoagulation (PRP). In patients who had uncomplicated rubeosis iridis without elevated IOP (n=6), after a mean of 3 injections, VA was stable in 4 patients and improved by two lines in 2 patients. In patients with early neovascular glaucoma (NVG) (n=13), IOP reduction was observed in all eyes within 1 week after injection but increased secondarily after an average of 45 days, although the rubeosis had definitively disappeared, which suggested that the change in IOP was independent of ASNV. After a mean of 6 injections in combination with filtering or cyclodestructive surgery, IOP finally stabilized, but VA decreased in all patients. Three patients (50%) with stage III ASNV progressed to stage IV ASNV in spite of anti-VEGF treatment. CONCLUSION: In all eyes, anti-VEGF treatment stopped neovascularization and helped to control IOP. However, vision was preserved only in the eyes with uncomplicated rubeosis at the time of diagnosis. Since only 32% of eyes were diagnosed at this stage, the authors suggest the prevention of ASNV by careful screening and follow-up of patients at risk, and the performance of PRP in CRVO with extensive retinal non-perfusion prior to the onset of rubeosis.

[Interest of optical coherence tomography performed immediately before intravitreal injection of anti-VEGF in exudative AMD]. / Intérêt de la tomographie à cohérence optique réalisée immédiatement avant injection intra-vitréenne d'anti-VEGF sur récidive exsudative dans la DMLA.

INTRODUCTION: Two or three systematic intravitreal injections (IVT) may be prescribed in a PRN approach to treat an exudative recurrence of neovascular age-related macular degeneration (AMD), according to the phenotype. Optical coherence tomography (OCT) may be performed immediately before the 2nd or the 3rd scheduled IVT, making it possible to cancel the procedure in the absence of exudation. The aim of the study was to evaluate the usefulness of this OCT examination and to assess the percentage of IVT cancelled, in order to evaluate a potential medico-economic benefit. METHODS: Monocentric retrospective study, in which were included 292 consecutive eyes with exudative recurrence of AMD, for which 2 or 3 IVT were scheduled between January 1st and April 30th, 2014. All patients received a first systematic IVT in the seven days following the diagnosis. Then, on the days of the 2nd and 3rd scheduled IVT, each patient had a visual acuity measurement and a Spectral domain-OCT (Spectralis, HRA Heidelberg Engineering). This measurement allowed for the IVT to be either performed as scheduled or cancelled. Both ranibizumab and aflibercept were used. A Chi(2) test was used to compare the qualitative variables and an adjusted Wilcoxon test for the quantitative values. RESULTS: Two hundred and ninety-two consecutive eyes were included; 172 in the "2 scheduled IVT" group (group A) and 120 in the "3 scheduled IVT" group (group B). At the first follow-up, 37.6% of scheduled IVT were cancelled after the OCT (44.1% in group A and 28.3% in group B). At the second follow-up, 33.3% of IVT were cancelled in group B. Overall, 150/412 (36.4%) IVT were avoided in this series. Presence of serous retinal detachment, retinal edema and increased central macular thickness were statistically correlated with confirmation of the scheduled IVT at the two follow-ups (P<0.001, P<0.001 and P=0.002, respectively). A savings of 429.80 € per patient was calculated during this short period of follow-up. CONCLUSION: An average non-injection rate of 36.4% of scheduled IVT was found in this protocol of management of recurrences with OCT performed the day of IVT. This protocol allowed to avoid unnecessary IVT one-third of the time and appeared highly cost-effective.

Intravitreal ranibizumab for neovascular age-related macular degeneration patients with good baseline visual acuity and the predictive factors for visual outcomes.

PURPOSE: To evaluate the efficacy of intravitreal ranibizumab for the treatment of neovascular age-related macular degeneration (nAMD) patients with a visual acuity (VA) of ≥ 20/40 and to investigate the predictive factors for visual outcomes. METHODS: The present study is a retrospective analysis of patients with VA ≥ 20/40. Injections were given monthly for the first 3 months and thereafter as needed. The patients were divided into two groups; group 1, patients not receiving further injections beyond the 3 loading doses, and group 2, those who received further injections. Next, group 2 was divided into two subgroups; group 2A, patients who did not experience VA loss, and group 2B, those who experienced VA loss. Data collected for each patient included VA and central retinal thickness (CRT) measured at baseline, months 3, 6, 9, and 12. RESULTS: The study included 96 eyes of 96 patients. Change in VA showed a significant inverse correlation with total number of injections at month 12 (r=-0.34, P=0.001), and the presence of pigment epithelial detachment (PED) at baseline (r=-0.35, P<0.01). VA outcomes were better in group 1 than group 2 at all time points (P<0.001 for all). Change in VA at month 3 was not significantly different between groups 2A and 2B (P=0.26); however, change in VA at month 6, 9, and 12 were statistically different between the two groups (P<0.001 for all). CONCLUSION: Intravitreal ranibizumab is an effective treatment for nAMD patients with good VA. The presence of PED, need for reinjection, and VA loss were unfavorable prognostic factors.

[Incidence of endophthalmitis after intravitreal injection: is antibioprophylaxis mandatory?]. / Incidence de l'endophtalmie après injection intravitréenne : peut-on se passer de l'antibioprophylaxie ?

INTRODUCTION: Endophthalmitis is the most dreaded complication after intravitreal injection. With the rise of antiangiogenics their rate is getting higher each year. The use of antibioprophylaxis is controversial. We tried to evaluate the impact of antibioprophylaxis on intravitreal injection endophthalmitis incidence. METHODS: All patients who received intravitreal injections between January 2007 and October 2012 were included in this retrospective study. Until June 2012 all patients had antibiotics the days following the injection. From July 2012 the antibiotic was replaced by an antiseptic immediately after the injection. RESULTS: An overall number of 11,450 injections were performed. The overall rate of endophthalmitis was 6/11,450 (0.052%). The incidence of endophthalmitis in the group with antibiotics was 3/10,144 injections (0.03%), 2 were culture proven (0.02%). The incidence in the group without antibiotics was 3/1306 (0.23%). The difference was significant (P=0.024). CONCLUSION: The incidence of endophthalmitis post-intravitreal injections seems to be lower when using antibiotics. However, a prospective study is mandatory to draw more robust conclusions.