Pegaptanib Sodium versus Pegaptanib Sodium Combined with Macular Laser Photocoagulation or Laser Alone for Diabetic Macular Edema.

Purpose. To report the outcomes after primary intravitreal pegaptanib sodium in patients with diabetic macular edema (DME). Methods. We conduced a retrospective analysis of eyes with DME treated with primary intravitreal pegaptanib sodium (Macugen) (intravitreal pegaptanib group). The results were compared with the ones of eyes treated with intravitreal pegaptanib sodium associated with macular laser photocoagulation (combined treatment group), and the ones of eyes treated with primary macular laser photocoagulation (macular laser photocoagulation group). Results. For the intravitreal pegaptanib group (13 eyes), we found significant changes in mean best-corrected visual acuity (BCVA) and reductions in mean central macular thickness (CMT) at the last follow-up visit (P = .0014 and P = .0001). For the macular laser photocoagulation group (15 eyes), we found no statistically significant changes in mean BCVA and CMT at the last follow-up visit (P > .05). For the combined treatment group (12 eyes), we found no significant changes in mean BCVA at the last follow-up visit (P > .05) despite significant reductions in mean CMT (P = .0188). Conclusion. Intravitreal pegaptanib treatment alone may be superior to macular laser photocoagulation alone and to combined intravitreal pegaptanib treatment associated with macular laser photocoagulation in patients with DME.

[Choroidal metastasis from clinically regressed prostate adenocarcinoma: imaging of a rare case]. / Métastase choroïdienne d'un adénocarcinome de la prostate: iconographie d'un cas rare.

INTRODUCTION: Choroidal metastases are often the revealing feature of malignant diseases. We report a rare case of prostatic adenocarcinoma metastases at the choroids, diagnosed and followed by fluorescein angiography (FA), indocyanine-green angiography (ICGA), and optical coherence tomography (OCT-3 Stratus). OBSERVATION: A 54-year-old man was referred to our department for decreased vision in his left eye lasting for 1 month. On ophthalmic evaluation, best corrected visual acuity (BCVA) was 20/20 in his right eye and 20/63 in his left eye. Biomicroscopic examination of the anterior segments did not reveal anything abnormal in either eye. Funduscopic examination revealed two amelanotic choroidal masses in both his right and left eyes, located at the posterior pole and at the periphery. The systemic workup, including hematologic analysis and total-body computed tomography (CT), revealed elevated serum prostate-specific antigen (PSA) and alkaline phosphatase, extensive abnormalities of the axial skeleton, and nodular pulmonary shadows; therefore, prostatic adenocarcinoma was suspected. Needle biopsies (prostatic and pulmonary) confirmed adenocarcinoma of the prostate, with metastatic disease. We decided to submit the patient to intermittent total androgen blockade alone, without adjunctive radiotherapy. The patient responded well to intermittent total androgen blockade with oral bicalutamide and triptorelin injection alone, as documented on fundus pictures, ultrasonography, OCT, FA, and ICGA. DISCUSSION: Prostatic carcinoma should be considered in any male patient with a choroidal mass suspected of being a metastasis. In our patient, FA, ICGA, and OCT clearly documented the complete regression of choroidal metastasis from prostatic carcinoma. Fluorescein angiography, indocyanine-green angiography, and optical coherence tomography are useful tools in the diagnosis and follow-up of prostatic adenocarcinoma metastatic to the choroid.

[Optical coherence tomography and fundus-related perimetry in spontaneous closure of a traumatic macular hole]. / Fermeture spontanée d'un trou maculaire post-traumatique évaluée par tomographie par cohérence optique et micropérimétrie.

We describe the spontaneous closure of a traumatic macular hole as evaluated with optical coherence tomography (OCT) and fundus-related perimetry. A 36-year-old man was examined by fundus biomicroscopy, ultrasonography, fundus-related perimetry, and OCT a few hours after injury to his left eye and during the following 18 months. At first examination, OCT showed a full-thickness macular hole, while fundus-related perimetry showed reduction of mean macular sensitivity, with an eccentric and unstable fixation. After 1 month, OCT scans showed complete closure of the macular hole, while fundus-related perimetry revealed a new eccentric but stable fixation (new preferred-retinal-locus). OCT and fundus-related perimetry seem to be useful tools to evaluate traumatic macular holes during follow-up.

[Efficacy of omega-6 essential fatty acid treatment before and after photorefractive keratectomy]. / Efficacité du traitement avec des acides gras essentiels oméga-6 administrés avant et après la kératectomie photoréfractive.

PURPOSE: Following PRK, a regression or the appearance of haze is often observed. This type of problem may be caused by an anomalous response by the stroma, probably mediated by keratocytes. Controlling keratocyte apoptosis therefore affects the outcome and stability of PRK. Inhibiting the transmission of the apoptosis signal from the damaged corneal epithelium to the keratocytes attenuates cell activation. This can be achieved by using a systemic product that will control the release of the mediators of the inflammation and stimulate tear production. The aim of this prospective, randomized study was to test the effects of a supplement containing omega-6 fatty acids (linoleic and (-linolenic acid), (-carotene, group B vitamins and trace elements (copper, zinc), when administered both before and after PRK. METHODS: Eighty subjects undergoing PRK were randomly divided into two groups. The group treated with omega-6 fatty acids included 18 females and 22 males, with a mean age of 32 years; the control group comprised 20 females and 20 males (mean age, 30 years). Statistical evaluation of the results was carried out on Schirmer test and fluorescein staining values and the state of the epithelium. RESULTS: In the Schirmer tests, a comparison between the two groups of patients who underwent surgery (groups 1 and 2) showed a statistically significant difference after 7, 15, and 30 days' treatment in favor of the group treated with omega-6 fatty acids. The values relating to the fluorescein staining test and the state of the epithelium showed a statistically significant difference in favor of the group treated with omega-6 fatty acids. CONCLUSION: These results confirm the real advantages of using omega-6 essential fatty acids to optimize and stabilize the outcome of PRK.

Correlation of visual function impairment and OCT findings in patients with Stargardt disease and fundus flavimaculatus.

PURPOSE: To investigate the relationship between morphologic lesions of the retina and functional abnormalities in patients with Stargardt disease (STGD) and fundus flavimaculatus (FFM). DESIGN. Case-controlled, prospective, comparative observational study. METHODS: A complete ophthalmologic examination, including best-corrected visual acuity (BCVA) and optical coherence tomography (OCT), was performed in 61 eyes of 32 consecutive patients with STGD/FFM and in 60 eyes of 30 matched healthy control subjects. Furthermore, fundus-related perimetry was performed in 12 of the affected eyes. RESULTS: The age ranged from 21 to 71 years in STGD/FFM patients and from 21 to 72 years in controls. BCVA ranged from 20/20 to 20/400 and from 20/20 to 20/32, respectively, in STGD/FFM patients and in controls. A foveal thinning was found by OCT Stratus in almost all cases (average 160 microm) compared with controls (average 210 microm) (p<0.001). BCVA impairment significantly correlated to the degree of foveal thinning (r2=0.16; p=0.0014). Moreover, in STGD/FFM patients the authors observed two types of hyperreflective deposits which were not correlated with BCVA impairment or foveal thinning. In addition, fundus-related perimetry revealed a stable fixation in 8/12 eyes, that was predominantly central in only 4 of these eyes. A smaller degree of foveal thinning correlated to a more stable fixation (p=0.0108), even if not predominantly central (p=0.0218). CONCLUSIONS: In this series, lower visual acuity and unstable fixation correlated with a greater transverse foveal thinning. OCT and fundus-related perimetry may be useful tools in STGD/FFM patients.

Intravitreal pegaptanib sodium for Irvine-Gass syndrome.

PURPOSE: To report the novel use of intravitreal pegaptanib sodium for the treatment of refractory cystoid macular edema (CME) following cataract extraction. METHODS: A 72-year-old man presented with decreased visual acuity in his right eye 8 months after uncomplicated phacoemulsification cataract extraction and intraocular lens implantation. His bestcorrected visual acuity (BCVA) was 20/125 in the affected eye, and fundus examination revealed CME despite 6 months of oral and topical indomethacin therapy. Fluorescein angiography (FA) showed leakage in the central region with no signs of neovascularization, and optical coherence tomography (OCT) confirmed the diagnosis with thickening of the fovea. Because of his history of glaucoma, the patient chose to be treated with intravitreal pegaptanib sodium 0.3 mg. RESULTS: At the 1-week follow-up, BCVA was 20/25, and the FA and OCT revealed almost total resolution of the CME with no adverse sequelae. Six months postinjection, the patient's BCVA remained 20/25 with no recurrence of CME. Perimetry revealed a stable fixation within 4 degrees with slight reduction of sensitivity. CONCLUSIONS: Vascular endothelial growth factor inhibition with intravitreal pegaptanib sodium appears to be of benefit in the treatment of chronic refractory CME with improvement of visual acuity. Studies evaluating pegaptanib''s use in this setting with long-term follow-up are warranted to confirm its efficacy and safety.

[Retinal abnormalities in adult acute myeloid leukemia: semeiological features and prognostic correlations. Analysis of 178 cases]. / Anomalies rétiniennes dans la leucémie myéloïde aiguë de l'adulte: séméiologie et corrélations pronostiques. A propos de 178 cas.

INTRODUCTION: Adult patients with acute myeloid leukemia (AML) frequently present retinal abnormalities. We tried to find a relationship between fundus lesions and treatment responsiveness, prognosis, and several hematologic parameters. PATIENTS AND METHODS: We examined 178 adult patients with newly diagnosed AML. All patients were assigned to two groups regarding retinal parameters (1 or 2) and age (A or B). Group 1 included cases with retinal dysfunction classified as retinal abnormalities with impaired visual acuity; group 2 included cases with no or only minor retinal changes. Subgroup A included patients younger than 60 years (n=97), subgroup B patients older than 60 years (n=81). RESULTS: In this study, higher age and a lower Hb value were associated with retinal findings (group 1). Among the younger patients (subgroup A), 78% of those with complete remission had no retinal findings (group 2) compared to 18% of the nonresponders. In the elderly population (subgroup B), this ratio was 58% versus 19%. In the younger patients (subgroup A), the mean overall survival was 50 months if they had no retinal abnormalities (group 2) and 7 months in the case of retinal changes (group 1). In the older population (subgroup B), the ratio was 15 months versus 3 months, respectively. CONCLUSION: Retinal abnormalities in AML are generally associated with higher age, although they correlate with a shorter survival in both age groups. This association is stronger in younger patients.