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1.
Acta Ophthalmol ; 2023 Nov 08.
Artículo en Inglés | MEDLINE | ID: mdl-37937745

RESUMEN

PURPOSE: The purpose of the study was to suggest a new method to calculate the intraocular lens (IOL) power in paediatric cataracts targeting emmetropia at the age of 15 years. METHODS: Data of children younger than 15 years who underwent cataract surgery with IOL implantation between 2005 and 2020 in the ophthalmological department of Marseille (South of France) was collected retrospectively. A logarithmic regression model was used to predict the axial length growth of the included eyes between implantation and 15 years. The predicted myopic shift served as target refraction to calculate a theoretical IOL power aiming for emmetropia at 15 years. Refractive error with the theoretical lens power was estimated as the spherical equivalent at the last follow-up minus the difference of target refractions between the implanted IOL and the theoretical one. Refractive errors using Dahan, Enyedi and Trivedi guidelines were also estimated and compared to the logarithmic model. RESULTS: Thirty-five eyes of 26 children were analysed. At the last follow-up, the median age of children was 10 years old and the median spherical equivalent was -1.88 dioptres (D) (IQR -3.81, -0.75). The estimated median refractive errors were 0.18 D (IQR -1.11, 1.42) with the logarithmic formula, -1.47 D (IQR -3.84, -0.65) with Dahan formula, -0.63 D (IQR -2.15, 0.32) with Enyedi formula and 0.38 D (IQR -1.58, 1.07) with Trivedi formula. CONCLUSION: The estimated refractive error with the new logarithmic formula is the closest to emmetropia at the last follow-up.

2.
Am J Ophthalmol ; 248: 1-7, 2023 04.
Artículo en Inglés | MEDLINE | ID: mdl-36228776

RESUMEN

PURPOSE: The purpose of this study is to assess the diagnostic accuracy of paracentral acute middle maculopathy (PAMM) in the setting of anterior ischemic optic neuropathy (AION) to distinguish arteritic (A-AION) from nonarteritic (NA-AION) type. DESIGN: Retrospective cross-sectional diagnostic evaluation. METHODS: PAMM was evaluated by 3 physicians blinded to diagnosis using macular spectral-domain optical coherence tomography. We studied 45 patients with AION. Of those, 28 had NA-AION and 17 had A-AION. The study was conducted in the Department of Ophthalmology at the Hospital of Marseille-Assistance Publique, France, from January 1, 2018, to March 31, 2022. RESULTS: PAMM were only found in the A-AION group (N = 4) (P = .0143). As a distinctive sign of A-AION, we found a specificity of 100% (95% IC, 88.06%-100%) and a positive predictive value of 100%. In contrast, sensitivity and negative predictive value were lower, 19.1% (95% IC, 5.5-42.0) and 63.0% (95% CI, 58.1-67.7), respectively. CONCLUSIONS: The PAMM finding is highly specific for A-AION in the setting of AION. According to our results, macular spectral-domain optical coherence tomography looking for PAMM should be performed with any patient presenting with AION.


Asunto(s)
Arteritis , Degeneración Macular , Neuropatía Óptica Isquémica , Humanos , Estudios Retrospectivos , Neuropatía Óptica Isquémica/diagnóstico , Estudios Transversales , Arteritis/diagnóstico , Tomografía de Coherencia Óptica/métodos
4.
Biomedicines ; 10(10)2022 Sep 28.
Artículo en Inglés | MEDLINE | ID: mdl-36289683

RESUMEN

Aim: We aimed to analyze changes in retinal microvascularization with intensive reduction of glycated hemoglobin A1c (HbA1c) in patients with poorly controlled diabetes using quantitative optical coherence tomography angiography (OCT-A) metrics. Method: This was a retrospective observational study in patients with uncontrolled diabetes admitted to the hospital for glycemic control. A second set of 15 healthy volunteers was included to serve as a control group. OCT-A was performed at inclusion and at 3 months to measure foveal avascular zone area (FAZA), vessel density (VD) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP), acircularity index (AI), and fractal dimension (FD). Results: This analysis included 35 patients (35 eyes): 28 type-2 diabetics and 7 type-1 diabetics. Mean HbA1c was 13.1 ± 2.0% at inclusion and 7.0 ± 1.5% at 3 months. In the short period from inclusion to 3 months post-inclusion, patients showed significant decrease in VD−DCP (28.8% vs. 27.8%; p = 0.014), a significant increase in FAZA (0.300 mm2 vs. 0.310 mm2; p < 0.001), and a significant increase in AI (1.31 vs. 1.34; p < 0.01). Multivariate analysis found an increase in FAZA was correlated with baseline HbA1c level and age (R2 = 0.330), and a decrease in VD-DCP was correlated with HbA1c decrease and diabetes duration (R2 = 0.286). Conclusions: Rapid glycemic control in patients with uncontrolled diabetes led to possible short-term microvascular damage that correlated to both initial and decreased HbA1c.

5.
Retina ; 42(7): 1370-1383, 2022 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-35234674

RESUMEN

PURPOSE: To report a cohort of patients diagnosed with retinal metastases (RM), and to integrate these new cases in a systematic review of the literature, analyzing the clinical features and prognosis factors of patients with RM. METHODS: We conducted a retrospective multicenter study including patients with RM. We also performed a full literature review of all published cases with a diagnosis of RM. RESULTS: A total of six new cases were described on multimodal imaging. By combining the data from the literature and from our patients, we report the characteristics of a total of 69 patients. The most frequent primary tumor sites were cutaneous melanoma (36%), lung (23%), gastrointestinal tract (17%), and breast (12%). Multimodal imaging highlighted specific characteristics of RM. Fluorescein and indocyanine green angiography revealed early hypofluorescence followed by progressive filling of intrinsic dilated vessels. Optical coherence tomography demonstrated a hyperreflective intraretinal mass in all cases with or without subretinal fluid, hyperreflective intraretinal dots, or intraretinal fluid. Ultrasonography revealed a medium-high reflective dome-shaped tumor. Fifty-nine percent of the patients died during the follow-up with a mean survival time of 8.8 ± 8.7 months. CONCLUSION: We described here the clinical spectrum of RM and highlighted specific features of the disease.


Asunto(s)
Melanoma , Neoplasias Cutáneas , Angiografía con Fluoresceína/métodos , Humanos , Melanoma/diagnóstico , Estudios Multicéntricos como Asunto , Retina , Estudios Retrospectivos , Tomografía de Coherencia Óptica/métodos
6.
Eur J Ophthalmol ; 32(1): NP185-NP186, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33153297

RESUMEN

INTRODUCTION: Neonatal herpes infections can be extremely severe and their early recognition allows for appropriate management and increases the child's chances of survival. CASE DESCRIPTION: We report the case of a premature infant born by vaginal delivery and transferred to intensive care after neonatal misadaptation. Examination of the fundus revealed lesions of acute bilateral retinal necrosis, strongly suggesting a herpetic etiology. CONCLUSIONS: This case highlights the clinical benefit of an ophthalmologic exam in newborns with equivocal brain lesions. Herein, the fundus examination allowed for high suspicion of herpes virus infection.


Asunto(s)
Encefalitis por Herpes Simple , Herpes Simple , Enfermedades del Prematuro , Síndrome de Necrosis Retiniana Aguda , Niño , Femenino , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Síndrome de Necrosis Retiniana Aguda/diagnóstico , Síndrome de Necrosis Retiniana Aguda/tratamiento farmacológico
8.
Eur J Ophthalmol ; 32(1): 356-363, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33779324

RESUMEN

PURPOSE: To report the visual and anatomic outcomes in treatment-naïve neovascular age-related macular degeneration (nAMD) patients treated with aflibercept under a standardized Treat and Extend (T&E) protocol for up to 3 years of follow-up in "real-life" practice. METHODS: This retrospective, observational, multicenter study included patients with treatment-naïve nAMD and at least 12 months of follow-up. T&E regimen adjustment was initiated after loading phase. At each visit best-corrected visual acuity (BCVA) and optical coherence tomography parameters were performed. RESULTS: One hundred and thirty-six eyes of 115patients had at least 1 year of follow-up with 114 and 82 eyes completing at least 2 and 3 years of follow-up, respectively (mean follow-up duration: 2.7 ± 1.3 years). Mean age was 78.6 ± 8.6 years old and 52% were women. Mean BCVA increased from 60.6 ± 18.7 letters at diagnosis to 66.9 ± 16.2 letters at 1 year (+6.3 letters, p = 0.003) and remained stable throughout the follow-up period (63.1 ± 20.3 letters (+2.5, p = 0.1) and 64.0 ± 20.1 letters (+3.4, p = 0.27) at 2 and 3 years, respectively). The mean central retinal thickness decreased significantly from 358.2 ± 87.9 µm at baseline to 302 ± 71.7 µm at 12 months and maintained stable after 36 months of follow-up (297.1 ± 76 µm, p < 0.0001). Mean number of injections was 6.6 ± 2.2, 4.8 ± 1.9, and 5.6 ± 1.7 at 1, 2, and 3 years, respectively. Mean cumulative number of 16.4 ± 5.6 injections after 3 years. Mean treatment interval was 6.8 ± 2.5 weeks at 1 year. Eight-week and 12-week treatment interval were achieved in 59.5% and 19.1%, 65.8%, and 36.8% and 69.5% and 41.5% at 1, 2, and 3 years, respectively. CONCLUSIONS: Our study demonstrated that intravitreal injections of aflibercept initiated under a standardized T&E for patients with treatment-naïve nAMD allow for significant visual improvement at 12 months, which was maintained over a 3-year follow-up period.


Asunto(s)
Inhibidores de la Angiogénesis , Degeneración Macular , Receptores de Factores de Crecimiento Endotelial Vascular , Degeneración Macular Húmeda , Anciano , Anciano de 80 o más Años , Inhibidores de la Angiogénesis/uso terapéutico , Femenino , Humanos , Inyecciones Intravítreas , Degeneración Macular/tratamiento farmacológico , Masculino , Receptores de Factores de Crecimiento Endotelial Vascular/uso terapéutico , Proteínas Recombinantes de Fusión/uso terapéutico , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Resultado del Tratamiento , Agudeza Visual , Degeneración Macular Húmeda/diagnóstico , Degeneración Macular Húmeda/tratamiento farmacológico
9.
Retina ; 42(3): 476-484, 2022 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-34723898

RESUMEN

PURPOSE: To report the occurrence of paracentral acute middle maculopathy (PAMM) in giant cell arteritis (GCA), describe its features and outcomes, and identify risk factors associated with PAMM in patients with GCA. METHODS: Review of medical records of patients with GCA who were examined in the Rothschild Foundation Hospital. Patients were divided into three groups: GCA with PAMM (Group 1), GCA with ophthalmic involvement but without PAMM (Group 2), and GCA without ophthalmic involvement (Group 3). We analyzed the data for age, sex, medical history, laboratory testing, visual acuity, and posterior segment vascular involvement. RESULTS: Among the 96 patients who met the inclusion criteria, 52 had ophthalmic involvement, and 16 patients were included in Group 1 (GCA with PAMM). In this subgroup, the mean age was 81.6 years and was found to be older than other groups. The visual prognosis was similar between Groups 1 and 2. Of the 20 eyes with PAMM, 35% were also associated with homolateral anterior ischemic optic neuropathy. No statistical difference was found in initial symptoms, signs, and laboratory testing. CONCLUSION: Paracentral acute middle maculopathy is frequently observed lesions in ocular GCA. Patients can present with isolated findings of PAMM as the only indication of GCA. Optical coherence tomography of the macula should be routinely performed in patients with suspected GCA, specifically if they complain of visual changes, to look for signs of ischemia in the middle layers of the retina. Isolated PAMM should raise suspicion for GCA in patients at risk.


Asunto(s)
Arteritis de Células Gigantes/diagnóstico , Isquemia/diagnóstico , Enfermedades de la Retina/diagnóstico , Vasos Retinianos/patología , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Agudeza Visual
10.
Int J Mol Sci ; 22(23)2021 Nov 23.
Artículo en Inglés | MEDLINE | ID: mdl-34884448

RESUMEN

Pathogenic variants in CRB1 lead to diverse recessive retinal disorders from severe Leber congenital amaurosis to isolated macular dystrophy. Until recently, no clear phenotype-genotype correlation and no appropriate mouse models existed. Herein, we reappraise the phenotype-genotype correlation of 50 patients with regards to the recently identified CRB1 isoforms: a canonical long isoform A localized in Müller cells (12 exons) and a short isoform B predominant in photoreceptors (7 exons). Twenty-eight patients with early onset retinal dystrophy (EORD) consistently had a severe Müller impairment, with variable impact on the photoreceptors, regardless of isoform B expression. Among them, two patients expressing wild type isoform B carried one variant in exon 12, which specifically damaged intracellular protein interactions in Müller cells. Thirteen retinitis pigmentosa patients had mainly missense variants in laminin G-like domains and expressed at least 50% of isoform A. Eight patients with the c.498_506del variant had macular dystrophy. In one family homozygous for the c.1562C>T variant, the brother had EORD and the sister macular dystrophy. In contrast with the mouse model, these data highlight the key role of Müller cells in the severity of CRB1-related dystrophies in humans, which should be taken into consideration for future clinical trials.


Asunto(s)
Células Ependimogliales/patología , Proteínas del Ojo/genética , Proteínas del Ojo/metabolismo , Degeneración Macular/patología , Proteínas de la Membrana/genética , Proteínas de la Membrana/metabolismo , Mutación , Proteínas del Tejido Nervioso/genética , Proteínas del Tejido Nervioso/metabolismo , Distrofias Retinianas/patología , Retinitis Pigmentosa/patología , Adolescente , Edad de Inicio , Empalme Alternativo , Niño , Preescolar , Células Ependimogliales/metabolismo , Proteínas del Ojo/química , Femenino , Estudios de Asociación Genética , Humanos , Lactante , Degeneración Macular/genética , Degeneración Macular/metabolismo , Masculino , Proteínas de la Membrana/química , Modelos Moleculares , Mutación Missense , Proteínas del Tejido Nervioso/química , Mutación Puntual , Distrofias Retinianas/genética , Distrofias Retinianas/metabolismo , Retinitis Pigmentosa/genética , Retinitis Pigmentosa/metabolismo , Estudios Retrospectivos , Eliminación de Secuencia , Adulto Joven
11.
J Craniofac Surg ; 32(7): 2344-2348, 2021 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-34054084

RESUMEN

PURPOSE: The aim of this study was to show the displacements and strain induced by the supraorbital band advancement during a craniofacial surgery for an anterior plagiocephaly on the orbital bones and the orbital content thanks to a numerical surgical simulation using the finite element method. METHODS: A three-dimensional (3D) finite element model of a child with an anterior plagiocephaly was entirely created from a tomodensitometry of a patient followed by our Craniofacial Pediatric team. Data of the tomodensitometry were computed with Slicer 3D to re-create the orbit geometry. Mesh production, properties of the model, and simulations of the fronto-orbital advancement were conducted on Hyperworks software (Altair Engineering, Inc., Detroit, MI, USA). RESULTS: The resulting 3D Finite Element Model was used to perform the supraorbital advancement simulation. Displacement and strain patterns were studied for orbital bones, oculomotor muscles, and eyeballs. Relative high strain in the both trochlear area and excycloration of the right orbit are among the most interesting results as torsional strabismus as V-pattern strabismus are often described in children with an anterior plagiocephaly. CONCLUSIONS: This pediatric Finite-Element Model of both orbits of a child with an anterior plagiocephaly showed the impact of the fronto-orbital advancement on the oculomotor system. This model described the relationship between the craniofacial surgery and the strabismus in the unilateral coronal synostosis. The advantages of this model are the many opportunities for improvement, including postoperative period and additional surgical procedures.


Asunto(s)
Craneosinostosis , Plagiocefalia , Niño , Análisis de Elementos Finitos , Humanos , Lactante , Músculos Oculomotores , Órbita/cirugía
14.
Retina ; 41(3): 563-571, 2021 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-33600133

RESUMEN

PURPOSE: To compare pseudocolor Optos ultrawidefield (UWF) retinal images with conventional real-color fundus photography (CFP) for detecting macular hyperpigmentary changes in intermediate age-related macular degeneration. METHODS: This retrospective study included 50 patients diagnosed with intermediate age-related macular degeneration. All patients underwent Optos imaging and CFP. The overall accuracy to visualize hyperpigmentation and its morphologic features was graded by two independent readers using a standardized grid. Structural and en face optical coherence tomography images were correlated with UWF and CFP images to determine spatial correspondence of pigment clumping on fundus images and hyperreflective foci on optical coherence tomography. RESULTS: One hundred eyes of 50 patients had hyperpigmentary changes on funduscopic examination and were included. The intragraders and intergraders agreements were high for all measurements (P < 0.001). At least one hyperpigmentary changes within the standardized grid was detected in 93% using CFP and 100% using UWF camera (P = 0.02). The total area of hyperpigmentation measured on UWF images was significantly higher than on CFP images (P < 0.001). There was a significant correlation between the presence of hyperpigmentary changes on both CFP and UWF images and hyperreflective foci on structural optical coherence tomography (P < 0.001). CONCLUSION: Ultrawidefield fundus images allow high detection and accurate quantification of macular hyperpigmentary changes in intermediate age-related macular degeneration compared with conventional CFP.


Asunto(s)
Angiografía con Fluoresceína/métodos , Degeneración Macular/diagnóstico , Oftalmoscopía/métodos , Epitelio Pigmentado de la Retina/diagnóstico por imagen , Tomografía de Coherencia Óptica/métodos , Anciano , Anciano de 80 o más Años , Femenino , Fondo de Ojo , Humanos , Masculino , Reproducibilidad de los Resultados , Estudios Retrospectivos , Agudeza Visual
18.
Eur J Ophthalmol ; 31(2): 754-758, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32507032

RESUMEN

PURPOSE: To compare the efficacy of intravitreal injections (IVI) of ranibizumab (Lucentis®, Novartis, Basel, Switzerland; RAN), aflibercept (Eylea®, Bayer, Leverkusen, Germany; AFL) and dexamethasone implant (Ozurdex®, Allergan, Irvine, California; DXI) in the treatment of naive diabetic macular oedema (DME) during a 12-month follow-up, in real life. METHODS: Nineteen eyes treated with RAN, 20 with AFL and 21 with DXI were analysed from inclusion up to 12 months (M12) with intermediate analysis at M6. Best corrected visual acuity (BCVA), fundus and central retinal thickness (CRT) using spectral-domain optical coherence tomography (SD-OCT; Spectralis/HRA, Heidelberg Engineering, Germany) were performed at inclusion, M3, M6 and M12. RESULTS: BCVA improved until 67.9 letters ±13.3 SD (+5.5 letters) at M6 and 69.6 letters ±12 SD (+7.2 letters) at 12 months for RAN group (p = 0.036). For the AFL group it improved until 63.6 letters ±15.2 SD (+6.6 letters) at M6 and 67.5 letters ±12.2 SD (+8.5 letters) at 12 months (p = 0.014). Lastly DXI group improved by 66.9 letters ±15.1 SD (+7.9 letters) at M6 and 68.4 letters ±11.2 SD (+9.4 letters) at 12 months (p = 0.0023). CRT decreased by 124.4 µm at M6 and 99.3 µm at M12 in RAN group, 144.3 µm and 101.5 µm in AFL group and finally 95.6 µm and 162.7 µm in DXI group. CONCLUSION: In summary, these three drugs provide an efficient treatment option with an acceptable benefit-risk ratio for the treatment of naive patients with DME, whether on BCVA or CRT on the first year of treatment.


Asunto(s)
Inductores de la Angiogénesis/administración & dosificación , Dexametasona/administración & dosificación , Retinopatía Diabética/tratamiento farmacológico , Edema Macular/tratamiento farmacológico , Agudeza Visual , Anciano , Retinopatía Diabética/complicaciones , Retinopatía Diabética/diagnóstico , Angiografía con Fluoresceína/métodos , Estudios de Seguimiento , Fondo de Ojo , Glucocorticoides/administración & dosificación , Humanos , Inyecciones Intravítreas , Edema Macular/diagnóstico , Edema Macular/etiología , Masculino , Estudios Prospectivos , Retina/diagnóstico por imagen , Factores de Tiempo , Tomografía de Coherencia Óptica/métodos , Resultado del Tratamiento , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores
19.
Eur J Ophthalmol ; 31(1): 130-137, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31550914

RESUMEN

PURPOSE: The aim of this study was to evaluate the efficacy and safety of ultrasonic cyclocoagulation in severe or refractory glaucoma, and to analyze the procedure-related inflammation. PATIENTS AND METHODS: In this retrospective study, 15 eyes of 13 patients suffering from severe or refractory glaucoma with uncontrolled intraocular pressure of ⩾21 mmHg underwent 8-s ultrasonic cyclocoagulation. A complete ophthalmic evaluation, quality of life assessment using Glau-Qol-17, endothelial cell count, and flare measurement were performed. Primary outcome was qualified surgical success (defined as intraocular pressure reduction from baseline ⩾20% and intraocular pressure >5 mmHg without hypotensive medication adjunction). Secondary outcomes were flare, endothelial cell loss, and quality of life. RESULTS: Qualified success was achieved in 67% of eyes at 6 months (mean intraocular pressure reduction = 42% in these eyes). During the first month after the procedure, the mean flare reached its maximum value when the intraocular pressure was minimal; the flare slowly decreased until normalization at month 3 when the maximal intraocular pressure was noted. At month 3, there was moderate but significant endothelial cell loss (11%), and no significant alteration in quality of life was demonstrated. CONCLUSION: The efficacy of ultrasonic cyclocoagulation in the present study is comparable to that reported in the literature. The kinetics of intraocular pressure and flare suggest that postoperative inflammation could be partly responsible for the early intraocular pressure decrease. The moderate endothelial cell loss, which could be caused by localized heating, and the preservation of quality of life confirm the safety of ultrasonic cyclocoagulation.


Asunto(s)
Cuerpo Ciliar/cirugía , Glaucoma/cirugía , Ultrasonido Enfocado de Alta Intensidad de Ablación/métodos , Anciano , Anciano de 80 o más Años , Antihipertensivos/uso terapéutico , Femenino , Glaucoma/fisiopatología , Humanos , Presión Intraocular/fisiología , Masculino , Persona de Mediana Edad , Calidad de Vida , Estudios Retrospectivos , Microscopía con Lámpara de Hendidura , Tonometría Ocular , Resultado del Tratamiento , Agudeza Visual
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