Correlation between aqueous flare and chorioretinal neovascularization in age-related macular degeneration following intravitreal bevacizumab injections.

PURPOSE: Prospective evaluation of aqueous flare following intravitreal bevacizumab (Avastin, Genentech Inc., San Francisco, CA, USA) injections in eyes with choroidal neovascularization due to age-related macular degeneration. PATIENTS AND METHODS: Sixteen eyes of eight patients were recruited. Aqueous humor flare was determined by laser flare meter every month after one intravitreal injection of 1.25mg of bevacizumab at baseline followed by a second injection at month3 (day 100±21days). Four patients received an injection at month6 (±10days), and one patient received an injection at month7. RESULTS: Two months after the first intravitreal bevacizumab injection, flare values decreased from 10±5.57 (mean±standard deviation) to 5.2±1.69photon count/ms (P=0.0207) and from 8.3±3.59 to 5.4±0photon counts/ms, 2months after the second injection (P=0.02). CONCLUSION: Significantly decreased aqueous humor flare levels were noted after repeated injections of bevacizumab.

[Intraocular foreign bodies (IOFB) of the posterior segment: retrospective analysis and management of 57 cases]. / Corps étrangers intraoculaires (CEIO) du segment postérieur : analyse rétrospective et prise en charge à propos de 57 cas.

PURPOSE: To determine the influence of prognostic factors and the type of tamponade agent in surgical management of intraocular foreign bodies (IOFBs) for better visual outcome. PATIENTS AND METHODS: Fifty-seven consecutive cases were retrospectively reviewed at the XV-XX National Hospital (Paris) between 1 January 2004 and 31 December 2007. Univariate and multivariate analyses were performed to identify prognostic variables. Several parameters were measured: pre- and postoperatively: best corrected visual acuity (BCVA), material and size of the foreign body, entry site, time from trauma to surgical removal, IOFB location, initial retinal detachment, choice of vitreous tamponade agent (none, gas, silicone oil), postoperative visual outcome, and complications (siderosis, endophthalmitis, and vitreoproliferative retinal detachment). RESULTS: Metal IOFBs accounted for the majority with 80.7% (n=46). The inferior retinal segment was the most frequent location found: 47.4% (n=27). Initial and final mean BCVAs were, respectively, 1.47 (±0.99) and 1.03 (±0.96) (LogMar scale). The mean follow-up was 20.7 months (range, 12-60 months). Initial retinal detachment was found in 24.56% (n=14), with a statically worse prognosis. The BCVA was better in the group with gas tamponade (n=16) than in the group with silicone tamponade (n=21) and the group without a tamponade agent (n=20). Initial BCVA was the most important predictive factor for final BCVA. Time to surgery was a predictive factor of final visual outcome with a cut-off in the first week. The scleral or corneoscleral entry site had a better prognosis than the corneal site. Five cases of siderosis (8.7%) related to delayed management and two cases of endophthalmitis (3.5%) were found (despite use of prophylactic systemic antibiotics). No statistical difference was found regarding the IOFB location on the retina, its size, or the material. Finally, the retina remained detached in nine cases (15.78%). A final BCVA of 20/40 or more was obtained in 39.3 and 17.5% had light perception or worse. CONCLUSION: The prognosis of an IOFB injury is for the most part uncertain due to a complex combination of parameters. Nevertheless, good postoperative results can be achieved without a silicone tamponade agent. The main prognostic factors related to better visual outcome were initial BCVA, time to surgery (first week), initially attached retina, and the scleral entry site. The main complications were vitreoproliferative retinal detachment, endophthalmitis, and siderosis. The location, type, and size of IOFBs were not statistically significant predictive factors in this study.

[Long-term results of the treatment of optic disc pit associated with serous macular detachment: a review of 20 cases]. / Résultats à long terme du traitement des fossettes colobomateuses de la papille compliquées de décollement séreux rétinien maculaire : à propos de 20 cas.

INTRODUCTION: The pathogenesis of the macular serous retinal detachment (SRD) associated with congenital optic disc pit remains controversial. The treatment is also discussed. Through this study, which includes the majority of the techniques available, we report our experiment in the treatment of this pathology. PATIENTS AND METHODS: This was a retrospective single-centre study of 20 patients who presented with macular SRD associated with optic disc pit between 1983 and 2009. Various treatments were provided. At the beginning of the study, patients were treated only by juxtapapillary laser photocoagulation. After laser failure then as first-line treatment, laser photocoagulation was associated with intravitreal gas (C3F8) injection with postoperative facedown positioning for 2 weeks. During the past few years, all patients have been systematically treated with vitrectomy with or without internal limiting membrane (ILM) peeling, laser, and gas (C2F6) tamponade. RESULTS: This series consisted of 20 patients: nine men and 11 women. The patients' mean age at presentation was 29 years (range, 9-60 years). The mean time between the onset of the decrease in visual acuity (VA) and treatment was 6.1 months. None of these patients had a posterior vitreous detachment at the time of diagnosis. Six patients were treated by laser photocoagulation alone, which was successful only in two cases. Eleven patients (with laser treatment failure in three) were treated by laser and intravitreal gas injection, with a 72% success rate. We performed vitrectomy with posterior hyaloid dissection, laser, and gas tamponade in eight cases (with laser-gas treatment failure in two) with 87% success rate and no recurrence. Five of these patients had ILM peeling during the vitrectomy. The mean follow-up period was 60 months (range, 2 months to 17 years). CONCLUSION: This study shows that early treatment of macular SRD associated with optic disc pit by vitrectomy, ILM peeling, juxtapapillary photocoagulation, and gas tamponade is followed by good anatomical and functional results. This treatment is superior to the other less invasive procedures. Optical coherence tomography is an important exam for diagnosis and postoperative follow-up of patients.

[Surgery of the idiopathic epimacular membrane on transconjunctival 25-gauge vitrectomy (TSV): a series of 50 cases]. / Chirurgie de membrane épimaculaire en vitrectomie transconjonctivale 25-gauge: à propos de 50 cas.

BACKGROUND: The surgery of the idiopathic epimacular membrane has gained from the advent of 25-gauge transconjunctival vitrectomy (TSV) initiated by Fujii in 2002. PATIENTS AND METHODS: In this retrospective study, we tested 50 patients operated on for epimacular membrane with 25-gauge TSV at the Quinze-Vingts National Ophthalmology Hospital in Paris from December 2004 to June 2006. RESULTS: No postoperative endophthalmitis, major hypotonia, or sclerotomy leakage were observed. However, two cases (4%) of retinal detachment and 47% postoperative cataract were noted at 3 months. After evolving 3 months later, distant and close visual acuity were significantly improved. CONCLUSION: TSV appears to be a useful method for epimacular membrane ablation.

[23-gauge transconjunctival sutureless vitrectomy: a retrospective study of 164 consecutive cases]. / Vitrectomie transconjonctivale 23-gauge: étude rétrospective de 164 cas consécutifs.

PURPOSE: To describe our initial experience and to evaluate the outcomes of patients treated with 23-gauge transconjunctival sutureless vitrectomy for a variety of vitreoretinal conditions. METHODS: A single-center, retrospective chart review of 164 consecutive 23-gauge vitrectomy cases done by five vitreoretinal surgeons at the CHNO des XV-XX from May 2006 through December 2007. The main outcome measures included visual acuity and intraoperative and postoperative complications. RESULTS: The mean follow-up duration was 145 days. Mean overall acuity improved from 20/410 (0.5/10) at baseline to 20/101 (2/10) (p<0.0001) and the improvement in visual acuity was statistically significant for patients with macular hole, epiretinal membranes, retinal detachment, nonclearing vitreous hemorrhage, and silicone oil removal. There was a single case of intraoperative retinal tear. There were no postoperative complications of endophthalmitis or choroidal effusion and three cases of hypotony, which resolved spontaneously. Thirty-six of 80 phakic eyes had worsening of cataract, 29 of which occurred in the 1st postoperative month. Twenty patients had cataract surgery during the follow-up. Postoperative retinal detachment occurred in two cases after surgery for nonclearing vitreous hemorrhage. Retinal re-detachment after surgery for retinal detachment occurred in nine of 66 cases (14%). CONCLUSIONS: Twenty-three-gauge transconjunctival sutureless vitrectomy is an effective surgical technique for a variety of vitreoretinal surgical indications. The safety and efficacy profile compared favorably with the published literature on 20-gauge surgery.

[25-Gauge transconjunctival vitrectomy in a case of bilateral epiretinal membrane associated with a Terson syndrome]. / Membrane épirétinienne bilatérale associée à un syndrome de Terson traitée par vitrectomie transconjonctivale sans suture à 25-gauges.

The formation of epiretinal membranes associated with proliferative vitreoretinopathy is known to be a complication of Terson syndrome. We report the first case of a 25-Gauge transconjunctival sutureless vitrectomy performed in one eye as treatment for an epiretinal membrane secondary to a case of Terson syndrome (most probably due to a history of subdural hematoma in childhood). Following a review of the current literature on the subject we report the physiopathologic mechanisms of Terson syndrome and the explanation for the proliferative vitreoretinopathy formation.

[Aspect of necrosis preceding macular hole from laser accident]. / Aspect de nécrose maculaire précédant un trou maculaire à la suite d'un accident de laser.

We report the clinical case of a 26-year-old victim of a macular injury by high energy laser. The patient was examined in the emergency unit the first day with a retinophotography. He was followed up at 1 week, 3 weeks, and 3 months with an ophthalmologic exam, a retinophotography, and an OCT. The lesions progressed from edema with macular hemorrhage to macular necrosis and then to a macular hole. The macular injury by high energy laser was responsible for a necrotic modification of the macula preceding the formation of the macular hole.

[Optical coherence tomography: a reliable tool for localisation of macular hemorrhage. Two case reports]. / Intérêt de la tomographie par cohérence optique pour localiser une hémorragie maculaire. A propos de deux cas.

Recent observations have found that premacular hemorrhage in Valsalva retinopathy is located under the internal limiting membrane. We confirm these findings in two case reports of Valsalva retinopathy. Visual acuity rehabilitation was obtained in the first case by conservative treatment and by draining the hemorrhage into the vitreous with Neodymium (Nd):Yag laser in the second case. We report the current therapeutic guidelines for Valsalva retinopathy, including the systematic search of autosomal dominant syndrome of retinal arterial tortuosity, a rare condition, often discovered after this type of benign macular hemorrhage.

[Usefulness of voriconazole in treatment of Phoma glomerata after penetrating injury]. / Endophtalmie à Phoma glomerata après plaie du globe et efficacité du traitement par voriconazole en intravitréen.

We report the first case of endophthalmitis caused by Phoma glomerata. A 32-year-old man who underwent retinal detachment surgery consecutive to a penetrating globe injury presented with endophthalmitis 7 days after surgery. Anterior chamber tap and intravitreal injection of antibiotics (ceftazidime and vancomycin) were performed systematically. Fungus was observed at microscopic examination of the aqueous humor and treatment with intravitreal injection of amphotericin B was decided. The patient failed to improve with intravitreal amphotericin B but responded clinically to intravitreal voriconazole. The fungus was identified after culture as Phoma glomerata. The MIC for amphotericin B was 1microg/ml, for caspofungin was 2microg/ml, and for itraconazole was 8microg/ml or more. The MIC for voriconazole was up to 8microg/ml. The clinical response after intravitreal injection may be related to the high concentrations reached in the vitreous. Because of severity and ominous prognosis of intraocular fungal infections and posttraumatic Phoma ocular infections, aggressive management is required by intravitreal voriconazole administration.

[Epiretinal membranes: reasons not to perform vitreoretinal surgery]. / Membranes épimaculaires: quelques bonnes raisons de s'abstenir.

Functional results after surgical removal of epiretinal membranes are good; most often, visual acuity improves and the macular syndrome disappears. Transconjunctival vitrectomy to perform peeling of epiretinal membrane has reduced postoperative impairment; however, the surgical complications remain the same. Epiretinal membranes are not uncommon in elderly. The surgical decision is not only based on visual acuity, but many other parameters are also considered. We provide a decision-making algorithm where the elements that suggest foregoing surgery are emphasized.

[Heavy silicone oil as internal tamponade for retinal detachment: efficacy and tolerance]. / Efficacité et tolérance de l'huile de silicone lourde dans la chirurgie du décollement de rétine.

INTRODUCTION: To evaluate the tolerance and efficacy of heavy silicone oil as internal tamponade for retinal detachment surgery. PATIENTS AND METHODS: Sixty-six eyes requiring heavy silicone oil for retinal detachment, with at least 1 month follow-up, were retrospectively studied. Preoperative status, surgical technique, tolerance, and anatomical and functional results were analyzed from the patient's file. Indications for heavy silicone injection were inferior retinotomy or inferior retraction in 65% of cases. PVR grade C was present in at least 63% of cases. Retinotomy was performed in 45% of cases. An exchange procedure was performed versus DKline in 65% of cases. Mean follow-up was 7 +/- 4 months. RESULTS: At the end of follow-up, 59% of eyes had a completely reattached retina, 32% without internal tamponade. Another surgery was necessary in 54% of cases. During follow-up, mean intraocular pressure was normal, and there was a significant intraocular inflammation in three cases (4.5%). In seven cases of the 44 ablations of heavy silicone oil, an adherence of residual bubbles was present. Redetachment occurred after ablation for anatomical success in 41% of cases. BCVA was better than 0.05 (20/400) in 54% of cases at the end of follow-up. CONCLUSION: Heavy silicone was well tolerated and seems not to be pro-inflammatory in our study. It is a good alternative to standard silicone for inferior retinotomy and inferior breaks without PVR. It is not a treatment of inferior retraction, and is not a long-term internal tamponade. During the ablation of heavy silicone oil, adherence of residual bubbles is possible, in which case a coaxial light or an endoillumination could be needed during ablation.

[Hereditary retinal pathologies and AMD: new therapeutic perspectives]. / Pathologies rétiniennes d'origine héréditaire et DMLA: nouvelles perspectives thérapeutiques.

This article summarizes our current knowledge on two types of retinal diseases: hereditary retinal degeneration and wet aged-related macular degeneration. Our understanding of retinal physiopathology in hereditary retinal degeneration and the successful experimental therapeutic results on animal models call for a new approach to these patients to prepare future clinical trials. Longitudinal follow-up of the functional alteration rhythm based on international standards and by expert centers is an essential prerequisite to including these patients in future clinical trials. Creating international databases that include data on follow-up using electrophysiological, psychophysical and morphological analyses would require standards defining how each of these procedures should be carried out. Furthermore, the relevance and value of the various examinations would then be evaluated in a longitudinal manner. The repeated use of these procedures in the various centers would bring to light any limitations these techniques may have for use in prospective studies. Continuous re-evaluation of these investigative techniques will therefore be necessary, a crucial factor in the preparation of multicenter clinical studies. The inclusion of patients phenotyped at different centers would require that certification procedures be set up for these centers. A great leap forward, clinical trials on new antiangiogenic approaches for the treatment of neovascular AMD are currently underway. The reasons for the switch between the neovascular and atrophic forms of AMD are as yet unknown, but these new approaches are based on the events that occur sequentially during the angiogenic response.

[Macular imaging with optical coherence tomography]. / Imagerie maculaire en OCT.

PURPOSE: Optical Coherence Tomography (OCT) is a novel noninvasive and noncontact imaging technique providing cross-sectional representations of the eye structures. OCT is analogous to Ultrasound B-scan, except that it analyzes the reflection of a 850 nm light wave. The aim of this study was to assess the potential of ocular coherence tomography for diagnosing and monitoring macular diseases. METHODS: Cross-sectional images were performed with the Zeiss-Humphrey OCT. Over one year period, we examined approximately 300 patients with idiopathic full thickness macular hole, lamellar hole, cystoid macular edema, choroidal new vessels, epiretinal membrane, diabetic maculopathy, and central serous chorioretinopathy. RESULTS: OCT can provide new information concerning the posterior pole diseases mentioned above. OCT can also be useful in thickness measurements. CONCLUSION: OCT allows tomographic analysis of macular diseases. The information obtained is different from that obtained by histologic study which is sometimes hard to interprete. OCT is mostly useful in studying internal layers of the retina. Further applications may be developed.

[Surgical treatment by vitrectomy and autologous serum of 36 idiopathic macular holes]. / Traitement chirurgical par vitrectomie et sérum autologue de trente-six trous maculaires idiopathiques.

PURPOSE: To analyse the surgical results of a second series of full thickness idiopathic macular hole operated with autologous serum as adjuvant therapy, and to compare them to the results of a first series without autologous serum and the results of literature. METHODS: In a series of thirty-six patients, autologous serum has been used as healing adjuvant therapy. The surgical procedure included a posterior and peripherical vitrectomy combined with posterior hyaloid separation, fluid-air exchange, autologous serum injection, and final flushing with 40% sulfur hexafluoride. The patients then maintained strict face-down position post-operatively for a minimum of ten days. RESULTS: Anatomic success was obtained in twenty-nine cases of thirty-six patients (80%), with an anatomic success rate of 100% for the stage 2 holes. Twenty-nine patients had a pre and postoperative measurable visual acuity. Among these twenty-nine patients, median postoperative visual acuity was 20/70, compared with 20/125 preoperatively. Final visual acuity was improved in twenty-seven patients (75%), was stable five times (14%), and declined four times (11%). Among the twenty-nine anatomic successes, twenty-four (85%) improved their visual acuity. Complications were rare, and observed in the same percentage as described in literature. No complication in relation to autologous serum was noticed. CONCLUSION: Autologous serum is an inexpensive, easy to obtain, healing adjuvant therapy. It seems improving the surgical results like the other adjuvants described in the litterature.