[Treatment delay in patients with first episode of retinal detachment in the studied eye in Midi-Pyrénées]. / Délai de prise en charge des patients atteints d'un premier épisode de décollement de rétine sur l'œil étudié en Midi-Pyrénées.

INTRODUCTION: Retinal detachment (RD) is a potentially blinding condition. Delay in management is a major prognostic factor. In our study, we analyzed the treatment delay for retinal detachments in the Midi-Pyrenees area, and factors which may influence it. MATERIAL AND METHODS: Observational, cross-sectional, multicentric study, carried out over a 6-month period. PRIMARY OUTCOME: time between diagnosis and surgery. Secondary outcome: time between first symptoms and surgery. Non-parametric tests were used to analyze the influence of sociodemographic features, clinical features, distance between home and surgical center, and occurrence over a weekend. RESULTS: One hundred and fiftty-nine patients were included. The mean time between diagnosis and surgery was 4.4 ± 12.3 days (2.7 ± 4.3 for recent RD, less than 1 month), and was increased by the presence of a weekend (P<0.001), or of a weekend with public holiday (P=0.023), and by macular detachment (P=0.008). The mean time between first symptoms and surgery was 12.0 days and was increased by the absence of RD history (P=0.023), and by macular detachment (P=0.046). No association was observed between these times to surgery and the distance between the patient's home address and the place of surgery. CONCLUSION: The time between diagnosis and surgery was relatively short in the Midi-Pyrénées area, but we often noted a delayed diagnosis, which may be due to the patient's lack of awareness of the symptoms and difficult access to specialty consultations. However, no relationship was found between this time-to-surgery and the distance between the patient's home and the surgical center.

[Intravitreal bevacizumab for treatment of neovascular glaucoma. Report of 20 cases]. / Utilisation du bevacizumab en injection intravitréenne dans le traitement du glaucome néovasculaire. A propos de 20 cas.

INTRODUCTION: Bevacizumab is a recombinant humanised monoclonal antibody directed against the vascular endothelial growth factor (VEGF). We report the results of bevacizumab injections in the treatment of 20 cases of neovascular glaucoma. PATIENTS AND METHODS: Seven women and 13 men, of average age 73 years old, presented with neovascular glaucoma secondary to central retinal vein occlusion in 8 cases, proliferative diabetic retinopathy in 8 cases, central retinal artery occlusion in 2 cases, radiation retinopathy in 1 case and ocular ischemic syndrome in 1 case. Iris fluorescein angiography was performed before and two days after 2,5 mg intravitreal bevacizumab. Diode laser cyclophotocoagulation was realised in 12 cases of grade 4 neovascular glaucoma in the week following the injection. Panretinal photocoagulation was conducted in all cases. RESULTS: After a 4 months and a half follow up, iris angiography revealed dramatic regression of iris neovascularisation in a few days. In grade 2 and 3 neovascular glaucoma, the single injection is sufficient to control intraocular pressure. In grade 4 neovascular glaucoma, intraocular pressure was controlled in 87,5 % of cases with one injection and one or more diode laser cyclophotocoagulation. DISCUSSION: The antiangiogenic effect of bevacizumab leads to fast reduction of the iris neovascularization with control of intraocular pressure without any surgery in grade 2 or 3 neovascular glaucoma. Panretinal photocoagulation was facilitated by improvement of corneal swelling. Diode laser cyclophotocoagulation was necessary in grade 4. CONCLUSION: Intravitreal bevacizumab was effective in reversing iris neovascularization in association with panretinal photocoagulation and cyclophotocoagulation.