Predictibility of the efficacy of peripheral iridotomy in primary angle closure: Utility of UBM.

PURPOSE: To assess the utility of UBM in the management of primary angle closure (PAC) and assessing the predictability of peripheral iridotomy (PI) in re-opening the closed angle. DESIGN: Retrospective clinical study. SUBJECTS: Patients with suspicion of PAC. METHODS: This study obtained the consent of all patients and adhered to the Declaration of Helsinki. It was conducted in two ocular imaging centers and based on patients with suspected PAC. Each patient underwent UBM and Visante OCT at each visit, before and after PI when PAC was confirmed. MAIN OUTCOME MEASURE: Irido-corneal angle. RESULTS: Out of 202 eyes (101 patients) with a mean age of 62 years and 69.3% female predominance, we found 186 eyes with PAC. In most cases (77.4%), the iridocorneal angle was open after a single PI at the second visit, and only 14% eyes remained closed at the third visit, regardless of any additional treatment performed (complementary PI, iridoplasty, surgical lens extraction). Mechanisms involved in persistent angle closure after PI were: imperforate PI (45.2% of eyes), iris plateau syndrome (8.6% of eyes), significant lens vaulting (30.9% of eyes) and mixed mechanisms (2.3% of eyes). CONCLUSION: PI remains effective as a first-line treatment in most cases of PAC, even when associated with mechanisms other than pupillary block. Nevertheless, the PI must be completely patent, and UBM can help in understanding underlying mechanisms, hence guiding the treatment in these eyes.

Predominantly Superior Retinal Tears Detected by B-Scan Ultrasonography.

INTRODUCTION: When fundus examination is not possible, ultrasonography (US) is an accurate tool for the diagnosis of retinal tears (RT). The aim of this study was to describe the predominant location of RT, the factors influencing their location, and the vitreous status of eyes with RT using US. METHODS: A prospective study was conducted in all patients diagnosed with RT by B-scan US (Aviso, Quantel Médical, Clermont-Ferrand, France). The primary endpoint was to assess RT preferential location using US. Secondary endpoints were the rate of posterior vitreous detachment (PVD), number of eyes with multiple RT, and axial length (AL). RESULTS: A total of 101 eyes of 100 patients with RT were included. RT main location was in the superior quadrants (either nasal superior, strictly superior, or temporal superior) in 71% of cases. All patients were diagnosed with PVD by US, and 79% had a vitreous hemorrhage. Twelve eyes (13%) were diagnosed with multiple RT. The mean AL was 24.62 ± 2 mm, and it was significantly longer in eyes without superior RT (25.52 mm versus 24.37 mm; p=0.004). CONCLUSION: In this study, we showed a superior location of RT diagnosed by US in more than two-thirds of cases associated with a significantly shorter AL than in other locations. This finding could increase US sensitivity for RT detection and help to improve the US learning curve of ophthalmologists in training and surgical decision-making when the retina is inaccessible due to opacity media.

[Management of wet AMD in France in 2015]. / Prise en charge de la DMLA exsudative en France en 2015.

PURPOSE AND CONTEXT: Intravitreal administration of anti-VEGF agents, available in France since 2007, allows stabilization and improvement in visual acuity in wet age-related macular degeneration (AMD). In the past few years, the management of this disease has evolved in terms of both diagnostic methods and treatment schedules, which have been adapted to the pathophysiology of AMD. The goal of this survey, performed in a representative sample of French ophthalmologists, was to describe the evolution of medical practices one year after a similar survey (Massé et al., J Fr Ophtalmol 2016; 39: 40-7). METHOD: The survey was performed from December, 2014 to March, 2015 in 191 ophthalmologists (53 general ophthalmologists and 98 retina specialists) with an on-line questionnaire. This questionnaire was designed by a committee of ophthalmologists to describe practices concerning screening, diagnosis, treatment and follow-up of wet AMD. RESULTS: An initial intravitreal injection of an anti-VEGF agent was usually performed within 10 days after the diagnosis of wet AMD by 98% of ophthalmologists and within 5 days by 63%. The treatment protocols favored by retina specialists were pro re nata (PRN) for 58%, Observe and Plan for 25% and Treat and Extend for 17%. Bilateral intravitreal injections were performed on the same day by 46% of retina specialists, mostly for the convenience of the patient and because of the low infectious risk. The initial protocol was maintained by one third of retina specialists throughout the course of treatment, while two thirds of them reported that they reassessed the protocol on average after 5 months. CONCLUSION: This survey on the practices of the ophthalmologists in wet AMD highlights an improvement in the time course of patient management and an evolution of treatment schedules toward individualized protocols.

[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.

[Overview of medical practices in wet AMD in France]. / Vue d'ensemble des pratiques médicales dans la DMLA exsudative en France.

BACKGROUND AND OBJECTIVES: Wet AMD is characterized by the formation of choroidal neovascularization, mediated by vascular endothelial growth factor (VEGF) and responsible for a decrease in visual acuity and metamorphopsia of sudden onset. Intravitreal anti-VEGF can stabilize or even improve visual acuity. Although there is a consensus among ophthalmologists about the induction phase injection of anti-VEGF, there appear to be differences in practice regarding therapeutic treatment modalities. The goal of this work was to explore this hypothesis and to better understand real life practices. METHOD: The Ipsos institute conducted a qualitative survey of 16 retinal specialists and 9 general ophthalmologists in September and October 2013, using a questionnaire developed by a scientific committee of experts. Fifteen telephone interviews and 4 face-to-face meetings with a retina specialist and an ophthalmologist were conducted. This qualitative study allowed the development of a quantitative survey of 200 retina specialists and general ophthalmologists, conducted between November 2013 and January 2014, to describe practices in diagnosis, treatment and follow-up of wet AMD. RESULTS: A distribution of roles between the ophthalmologist making the initial diagnosis and the retinal specialists responsible for treatment and follow-up was noted. Treatment was initiated within 10 days of diagnosis as recommended by the HAS in only one third of patients. After the induction phase of treatment, i.e. three monthly injections of anti-VEGF, treatment and monitoring practices were heterogeneous with 74% of physicians using a PRN treatment protocol, 22% a bimonthly protocol (with monthly monitoring in 19.4% of cases) and 4% a "treat and extend" protocol. There was little change in the protocol chosen in the case of recurrence. CONCLUSION: Three quarters of ophthalmologists report using a PRN protocol, and over 90% report seeing their patients monthly, either for injection or for a check-up. This apparent uniformity is in reality more complex: for the large majority, they prefer to closely follow the patient so as to treat the slightest recurrence, but with great variability in practices with regard to individualization of treatment.

[A case report of transient myopia following blunt trauma]. / Myopie transitoire post-traumatique ? À propos d'un cas.

We present a case report on a young man complaining of transient myopia following a blunt trauma. Clinical and paraclinical (ultrasound) follow-up allowed us to discuss the different physiopathological mechanisms involved. We observed anterior lens displacement, increased lens thickness probably due to lens edema, choroidal detachment, and ciliary body edema. Progression was positive with full regression of the myopia. Ultrasound analysis also underlined an iridocorneal angle closure that could have led to angle-closure glaucoma (preventive peripheric iridotomy was discussed). The spontaneous progression showed spontaneous angle reopening on the main meridians.

[Pseudoexfoliation syndrome and phacoemulsification: comparative study with a control population]. / Syndrome pseudoexfoliatif et phakoexerèse : étude comparative à une population témoin.

PURPOSE: To determine the outcomes in cataract surgery by phacoemulsification in eyes with pseudoexfoliation syndrome (PEX) compared with eyes without this syndrome and to analyze the clinical features of pseudoexfoliation syndrome. PATIENTS AND METHODS: A retrospective, single-center comparative study was conducted on patients who underwent cataract surgery between January 2006 and December 2008. Demographic parameters (age, sex, ethnicity, medical and ophthalmologic history), clinical features (visual acuity, pupil dilatation, intraocular pressure) before and after surgery, and surgery complications were analyzed and compared to a control group without PEX. RESULTS: One hundred and four eyes of 81 patients were included in the study. The eyes were divided into two groups: 52 eyes with pseudoexfoliation syndrome (PEX) and 52 eyes without pseudoexfoliation (control group). The rate of surgical complications was not statistically different between the pseudoexfoliation and control groups. The mean preoperative and postoperative visual acuity were not statistically different between the two groups. The mean postoperative visual acuity was LogMAR 0,06 + or - 0,2 in the pseudoexfoliation group and LogMAR 0,03 + or - 0,06 in the control group. The mean follow-up was 1,4 + or - 1,3 months in the pseudoexfoliation group and 1 month in the control group. Pseudoexfoliation was bilateral in 72 % of cases. Open-angle glaucoma or ocular hypertension was associated in 21 cases (40 %) in the pseudoexfoliation group versus no open-angle glaucoma and five cases of ocular hypertension in the control group (10 %). Poor pupil dilatation was observed in 25 cases (48 %) in the pseudoexfoliation group and in two cases (4 %) in the control group. Phacoemulsification with IOL was the surgical technique in all the cases, with only one case of anterior chamber IOL in the pseudoexfoliation group. DISCUSSION: Cataract surgery in PEX is known to be associated with more complications during surgery. Poor pupil dilatation is one of the most common problems in cataract surgery in eyes with PEX. Nevertheless, the cataract surgery in eyes with PEX syndrome is not associated with a higher rate of surgical complications in our study. However, PEX required optimized surgery. Pseudoexfoliation syndrome is most common in its bilateral presentation. It is associated with chronic secondary open-angle glaucoma. The best visual acuity after surgery was similar in the two groups, but PEX required more time to attain this maximal visual acuity. Coronary heart disease could occur more frequently in patients with PEX compared with subjects without PEX. CONCLUSION: Pseudoexfoliation syndrome did not confer a statistically higher risk for surgical complications in eyes without marked phacodonesis or lens subluxation. Pseudoexfoliation syndrome did confer a higher risk for glaucoma and coronary ischemia.

[Evaluation of the Ocular Response Analyzer in ocular hypertension, glaucoma, and normal populations. Prospective study on 329 eyes]. / Evaluation des facteurs biomécaniques cornéens mesurés à l'Ocular Response Analyzer dans l'hypertension intraoculaire, le glaucome primitif à angle ouvert et chez le sujet normal. Etude prospective sur 329 yeux.

OBJECTIVES: (1) Evaluate and analyze the Ocular Response Analyzer (ORA) in three groups of patients: glaucoma, intraocular hypertension, and normal; (2) study corneal hysteresis values in the three groups according to age; and (3) compare intraocular pressure values measured with the ORA with intraocular pressure measured with Goldmann (IOPGoldmann) and pulsed air (IOPair) applanations. MATERIAL AND METHODS: This prospective, single-center study included 329 eyes divided into three groups: normal (n=207), intraocular hypertension (n=55), and primary angle glaucoma (n=67). Corneal hysteresis (CH), IOP corneal-compensated (IOPcc), and Goldmann correlated IOP (IOPg) measurements were provided by the ORA device for all patients. Ultrasonic central corneal thickness (CCT US), and intraocular pressure measured with Goldmann and pulsed air tonometry were also assessed in each eye. RESULTS: The mean values were: IOPGoldmann 14.4+/-3.4 mmHg, IOPair 15.5+/-3.6 mmHg, CCT 542.1+/-36.6 microm, CH 10+/-1.7 mmHg, IOPcc 16.6+/-4.1 mmHg, and IOPg 15.7+/-3.9 mmHg. All the IOP measurements (IOPGoldmann, IOPair, IOPg, IOPcc) were strongly correlated into the three age groups. The mean CH in the glaucoma (9.8 mmHg) and intraocular hypertension (9.6 mmHg) groups was lower than in the normal group (10.3 mmHg), but there was no difference between the three groups for the CH values, with an age-related analysis of the three groups. The CH was correlated with CCT US in the three groups. IOP measures were not strongly correlated with CH except for IOPcc. There was a negative correlation (-0.79) between CH and IOPcc. DISCUSSION/CONCLUSION: In our study, the mean ORA, CCT US, and IOP values in the normal group were similar to those found in the literature. These are the first CH values reported for a normal group according to age. We confirm the good correlation between all the IOP measurements. The mean corneal hysteresis value was low in glaucoma and intraocular hypertension, but there was no difference between the three groups for the CH values, when the three groups were analyzed according to age. There was a correlation between corneal hysteresis and central corneal thickness. Moreover, IOPcc seems to be the best evaluation of IOP with no influence from corneal biomechanical factors. The Ocular Response Analyzer and corneal hysteresis should be considered a useful parameter for patients with intraocular hypertension and/or glaucoma.

[Pseudoexfoliation syndrome in cataract surgery. Retrospective study of 37 cases]. / Le syndrome de pseudo-exfoliation capsulaire dans la chirurgie de la cataracte. Etude rétrospective de 37 cas.

PURPOSE: To analyze the clinical features of pseudoexfoliation syndrome and to determine complications in cataract surgery in eyes with pseudoexfoliation syndrome compared with eyes without this syndrome. METHODS: A retrospective, single-center comparative study was conducted on patients who underwent cataract surgery between 2004 and 2006. Demographic parameters (age, sex, ethnicity, medical and ophthalmologic history), clinical features (visual acuity, pupil dilatation, intraocular pressure) before and after surgery, and surgical complications were analyzed and compared to a control group without pseudoexfoliation. RESULTS: Seventy-four eyes of 71 patients were included in the study. The sex ratio of the pseudoexfoliation group was 1.26 with 19 males (56%) and 15 females (44%). Pseudoexfoliation was unilateral in 21 cases (61%). Open-angle glaucoma was associated in 11 cases (32%) in the pseudoexfoliation group versus two cases in the control group (5.4%). Poor pupil dilatation was observed in eight cases (24%) in the pseudoexfoliation group and in one case (2.7%) in the control group. Phacoemulsification with IOL was the surgical technique in all the cases with only one case (2.7%) of anterior chamber IOL in the pseudoexfoliation group. There was no significant difference in the surgical complications between the pseudoexfoliation and control group (5.4%). The mean preoperative intraocular pressure was 16+/-5 mmHg in the pseudoexfoliation group and 14+/-3 mmHg in the control group. The mean postoperative intraocular pressure at 1 month was 14+/-4 mmHg in the pseudoexfoliation group and 14+/-3 in the control group. The mean preoperative visual acuity was 1.0+/-0.7 LogMar in the pseudoexfoliation group and 0.7+/-0.5 LogMar in the control group. The mean postoperative visual acuity was 0.4+/-0.6 LogMar in the pseudoexfoliation group and 0.2+/-0.1 LogMar in the control group. The mean follow-up was 70 days in the pseudoexfoliation group and 30 days in the control group. CONCLUSION: Pseudoexfoliation syndrome is the most common in its unilateral presentation. It is frequently associated with chronic secondary open-angle glaucoma. Poor pupil dilatation is one of the most common problems faced by cataract surgeons. Nevertheless, pseudoexfoliation syndrome did not confer a statistically higher risk for surgical complication in eyes without marked phacodonesis or lens subluxation.

[Phacoemulsification in eyes with white cataracts: results and complications]. / La phacoémulsification chez les patients atteints de cataracte blanche: résultats et complications.

PURPOSE: To compare visual acuity and complications in phacoemulsification in eyes with white cataract and in eyes with immature senile cataract. PATIENTS AND METHODS: This was a prospective study on 36 eyes in 34 patients with white cataract (group 1) and 36 eyes in 36 patients with immature senile cataract (group 2). RESULTS: In group 1, mean preoperative visual acuity was 1/100 and mean postoperative visual acuity was 5/10 at 1 month. Posterior capsule tears occurred in four eyes (11%). In group 2, mean preoperative visual acuity was 2/10 and mean postoperative visual acuity was 7/10 at 1 month. No posterior capsule tear was observed. The preoperative visual acuity was significantly lower in group 1 (p=1.8x10(-14)). Postoperative visual acuities were not significantly different between the two groups (p=0.07). The increase in visual acuity was significantly higher in group 1 (p=2.2x10(-11)). DISCUSSION: Our study shows that white cataract is not a risk factor of poor postoperative visual acuity and the increase in visual acuity is greater in the white cataract group than in the immature cataract group. CONCLUSION: The results of phacoemulsification in white cataracts are satisfactory in spite of a high rate of posterior capsule rupture in our study.

[Uveitis associated with thyroïditis in HTLV-1 carriers]. / Uvéite et thyroïdite associée à HTLV-1.

INTRODUCTION: The oncovirus HTLV-1 is aetiologically associated with uveitis and autoimmune thyroiditis in endemic areas. The association of uveitis with autoimmune thyroiditis in HTLV-1 carriers is less common moreover in non-endemic area. EXEGESE: We report two original cases of simultaneous uveitis and autoimmune thyroiditis in HTLV-1 carriers, without other disease due to HTLV-1. The visual outcome was favorable in both cases. CONCLUSION: A significant correlation exists between hyperthyroidism, uveitis and HTLV-1, but still needs to be confirmed. The autoimmune or immune mediated mecanism of HTLV-1 may be involved in the uveitis and the thyroidits.