Patient experience of anti-vegf intravitreal injection.

Intravitreal anti-vascular epithelial growth factor (anti-VEGF) injections have revolutionised the treatment of macular diseases, but can be stressful for the patient. We surveyed 904 patients receiving injections at 5 centres in France regarding their feelings toward anti-VEGF injections. The mean age was 77.4 years, and the injections were performed mostly for age related macular degeneration (72%). Half of the patients had previously received>10 injections, 35.6% had received 3-10 injections, and 14.2% had received<3 injections. The mean (SD) stress score was 4.2 [on a scale from 1-10 (0=least stressful, 10=extremely stressful)]. Most patients (70%) reported low to moderate stress (score ≤5). The number of previous injections did not influence stress scores. Paradoxically, 61.2% of patients reported finding injections to be less stressful over time. Most patients found injections to be less traumatic than expected (64%) or just as they had anticipated (25%). Most patients (88%) were not bothered by the presence of other patients in the waiting room. Most patients (78.8%) preferred to be injected quickly before they had time to feel stressed about the procedure. Injections were generally well accepted; most patients would prefer to maintain their current schedule of injections and their current vision (55.7%), or would be willing to have more frequent injections for better vision (39.5%). Our results suggest that stress appears to be more related to the patient's psychological make-up than to the treatment experience or the number of injections received.

Artificial intelligence to diagnose meniscus tears on MRI.

PURPOSE: The purpose of this study was to build and evaluate a high-performance algorithm to detect and characterize the presence of a meniscus tear on magnetic resonance imaging examination (MRI) of the knee. MATERIAL AND METHODS: An algorithm was trained on a dataset of 1123 MR images of the knee. We separated the main task into three sub-tasks: first to detect the position of both horns, second to detect the presence of a tear, and last to determine the orientation of the tear. An algorithm based on fast-region convolutional neural network (CNN) and faster-region CNN, was developed to classify the tasks. The algorithm was thus used on a test dataset composed of 700 images for external validation. The performance metric was based on area under the curve (AUC) analysis for each task and a final weighted AUC encompassing the three tasks was calculated. RESULTS: The use of our algorithm yielded an AUC of 0.92 for the detection of the position of the two meniscal horns, of 0.94 for the presence of a meniscal tear and of 083 for determining the orientation of the tear, resulting in a final weighted AUC of 0.90. CONCLUSION: We demonstrate that our algorithm based on fast-region CNN is able to detect meniscal tears and is a first step towards developing more end-to-end artificial intelligence-powered diagnostic tools.

[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.

[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.

[Epidemiology of age related macular degeneration]. / Epidémiologie de la dégénérescence maculaire liée à l'âge.

Age-related macular degeneration (ARMD) is a multifactorial and polygenic disease and is the main cause of vision loss in developed countries. The environmental factors of ARMD can modify prevalence and incidence of this disease. This article is a review of the main environmental factors currently recognized as at risk or protective factor for ARMD. Modification of these factors is of crucial importance because it could delay the onset of exudative or atrophic forms of the disease.

Clinical evaluation of the use of infracyanine green staining for internal limiting membrane peeling in epimacular membrane surgery.

PURPOSE: To evaluate the use of infracyanine green (IFCG) staining in idiopathic epiretinal membrane (ERM) surgery. METHODS: A retrospective comparative study of 63 consecutive eyes with ERM operated on with internal limiting membrane (ILM) peeling using or not filtered IFCG diluted (5:1) in glucose 5%. Main outcome measures were best-corrected visual acuity, central visual field perimetry, fluorescein angiography with blue light fundus photograph, optical coherence tomography (OCT), and in seven eyes multifocal electroretinogram (mfERG). RESULTS: A total of 44 eyes underwent surgery with ILM staining using IFCG and 19 eyes without. In the IFCG group, the staining showed that the ILM was removed together with the ERM in 39% of eyes; ILM was still present on the macula after ERM removal in 57% of eyes and removed secondarily. The improvement in vision was slightly better in the IFCG group throughout follow-up but the difference was not significant. On the postoperative blue light photograph, defects in the optic nerve fibre layer were less frequent in the group with IFCG than without (p=0.023), suggesting less peroperative trauma. Two eyes in the group operated without IFCG had recurrence of the ERM including one with a macular hole vs none in the group with IFCG. No difference was observed in the groups as regards central visual field testing, mfERG, OCT, or angiographic data. CONCLUSIONS: Using IFCG for ILM peeling in ERM surgery seemed to reduce significantly the trauma to the optic nerve fiber layer and to prevent ERM recurrence. Deleterious effects were not observed in this study.

[Pseudomigraine with transient neurological deficits and cerebrospinal fluid lymphocytosis]. / Pseudo-migraine avec déficits neurologiques transitoires et lymphocytose du liquide céphalo-rachidien.

INTRODUCTION: Pseudomigraine with temporary neurological symptoms and lymphocytic pleocytosis is a rare syndrome resolving within less than 3 months. CASE REPORT: A young 17-year-old woman without previous medical history was admitted to the hospital because of right motor weakness and language disturbances. The symptoms resolved in a few hours and were followed by severe left headaches with important vegetative signs. Several similar episodes were noted in the previous 10 days. Cranial MRI was normal. EEG showed important slowing of the cerebral electrogenesis. More than 250 lymphocytic cells were found at CSF analysis. Outcome was spontaneously favorable, without similar symptoms after 6-month follow-up. CONCLUSION: Pseudomigraine with lymphocytic pleocytosis seems to be a particular syndrome of unknown origin. This is an elimination diagnosis, generally with a benign course.

[Surgical treatment of cancer of the left colon. True left hemicolectomy or segmental colectomy?]. / Le traitement chirurgical du cancer du côlon gauche. Hémicolectomie gauche vraie ou colectomie segmentaire?

Non-metastatic cancer of the left colon is still an exclusively surgical problem in 1988. The problem is to determine which type of colectomy should be performed: either a true left hemicolectomy, a long but apparently oncologically satisfactory operation, or segmental colectomy. A recent study by A.R.C. reported the same 5-year survival for these two types of operation with essentially identical postoperative mortality and morbidity. This conclusion confirms that of many studies published on this subject.

A union and consumer proposal for the regulation of enhanced natural radiation.

This paper discusses the problems related to enhanced exposure of workers to natural radiation and other pollutants in the working and living environment, with particular attention to radon. A method is proposed for regulating this high priority problem, which also considers the variable borderline between the controllable and uncontrollable exposure contributions. It is based on the principles of an integrated health policy regarding air quality. The complex multiple source exposure in private dwellings, at the workplace and through consumer goods should be taken into account as discussed in recent WHO and ILO reports. The important role of ventilation practices for future health is put forward. As far as regulation of exposure to ionizing radiation is concerned the present Euratom Basic Safety Standards are considered inadequate. Particular attention is given to a specification of justification and optimization and to a practical use of a hierarchy of limits as defined in the IAEA/ILO/WHO/NEA Basic Safety Standards.

[Ethmoidal fibroma in an 18-month-old infant (author's transl)]. / Fibrome ethmoïdal chez un nourrisson de 18 mois.

A case of ethmoidal fibroma in an 18-month-old infant is reported, and nosological, histological, and pathogenic features of this rare affection discussed. Though similar in some respects to Jaffe Lichtensteins fibrous dysplasia in its localized form, it differs, in that it sometimes runs a rapid course and has a tendency to relapse.