LONG-TERM PROGNOSIS OF CHOROIDAL NEOVASCULARIZATION COMPLICATING ANGIOID STREAKS.

PURPOSE: To report the very long-term visual prognosis of choroidal neovascularization complicating angioid streaks in the antivascular endothelial growth factor era. METHODS: Retrospective monocentric study aimed at analyzing patients' demographics, choroidal neovascularization features, angioid streak-associated conditions, and previous and current therapies for choroidal neovascularization. The main outcome measures were the quantitative measurement of central retinal pigment epithelial atrophy enlargement by comparing the ratio of pixels involved on automated infrared images acquired by spectral-domain optical coherence tomography and the changes in best-corrected visual acuity. The secondary outcome measures were the number of intravitreal injections and the changes in central choroidal thickness and central retinal thickness. Subgroup analyzes were performed to compare macular atrophy extent between eyes of patients with or without proven pseudoxanthoma elasticum ("PXE" or "no PXE") and between eyes previously treated or not with photodynamic therapy ("PDT" or "no PDT"). RESULTS: Thirty-three eyes of 23 patients were included. The mean best-corrected visual acuity decreased significantly from 66 ± 19 Early Treatment Diabetic Retinopathy Study letters at the time of the first antivascular endothelial growth factor injection to 52 ± 23 Early Treatment Diabetic Retinopathy Study letters at the end of the follow-up (mean follow-up duration: 109 ± 42 months, range: 47-175 months). The ratio of central retinal pigment epithelial atrophy enlargement was 201%, 110%, 240%, and 111% in the PXE, no PXE, PDT, and no PDT groups, respectively. CONCLUSION: Despite the use of antivascular endothelial growth factor agents, the very long-term prognosis appeared relatively poor, especially in patients with PXE. This study also suggests that PDT should be used with caution in the management of choroidal neovascularization in eyes with angioid streaks.

Inaugural severe vaso-occlusive retinopathy in systemic lupus erythematosus.

Purpose To report the case of a patient with an inaugural severe bilateral vaso-occlusive retinopathy due to systemic lupus erythematosus. Method Clinical examination, fundus pictures and fluorescein angiography were performed. Results A 26-year-old, healthy, African man presented with a meningo-encephalitic syndrome and a severe bilateral visual impairment. The fundus examination revealed multiple retinal vascular occlusions, and a fluorescein angiography showed retinal and choroidal ischemia bilaterally. In addition, based on the neurologic disorders, a pleuritis, a renal disorder and a hematologic disorder, systemic lupus erythematosus, was diagnosed. Conclusions Severe vaso-occlusive retinopathy in a 26-year-old man resulting in a significant visual loss as the initial manifestation of systemic lupus erythematosus. Central nervous system involvement during lupus might be more frequent in patients when serious retinal changes occur.

Influence of a capsular tension ring on ocular aberrations after cataract surgery: a comparative study.

PURPOSE: To evaluate the effects of a capsular tension ring on ocular and corneal aberrations after cataract surgery. METHODS: In this prospective, randomized, contralateral eye study, 20 patients who underwent bilateral cataract surgery were divided into two groups: eyes that received the capsular tension ring (CTR group) and fellow eyes that did not receive the capsular tension ring (IOL group). Total optical aberrations were measured 3 months postoperatively. Ocular and corneal aberrations were analyzed to determine whether statistically significant differences were present between groups. RESULTS: In the CTR group, the root-mean-square (RMS) for total aberrations and total higher order aberrations were 2.13+/-1.17 microm and 1.01+/-0.89 microm, respectively. The RMS for tilt, coma, trefoil, and spherical aberration were 1.05+/-0.65 microm, 0.45+/-0.32 microm, 0.47+/-0.19 microm, and 0.31+/-0.12 microm, respectively. In the IOL group, the RMS coefficient for total aberrations and total higher order aberrations were 2.01+/-1.30 microm and 0.88+/-0.34 microm, respectively. The RMS for tilt, coma, trefoil, and spherical aberration were 0.58+/-0.35 microm, 0.29+/-0.18 microm, 0.49+/-0.26 microm, and 0.32+/-0.21 microm, respectively. Tilt was statistically significantly higher in the CTR group compared with the IOL group (P=.0009). Postoperatively, there were no other differences between groups (P>.05). CONCLUSIONS: The use of the capsular tension ring caused an increase in tilt aberration after cataract surgery and does not seem to improve the optical performance of conventional intraocular lenses after uneventful cataract surgery.

Ocular aberrations after cataract surgery with hydrophobic and hydrophilic acrylic intraocular lenses: comparative study.

PURPOSE: To compare tilt and some higher-order aberrations (HOAs) in patients who had cataract surgery and implantation of 2 types of acrylic intraocular lens (IOL), the hydrophobic MA60AC (Alcon) or the hydrophilic XLSTABI (Ioltech). SETTING: Fondation Ophtalmologique Adolphe de Rothschild, Department of Pr Hoang-Xuan, Paris, France. METHODS: Sixty eyes were included in this study. Eyes in group 1 (n = 30) received the acrylic hydrophobic MA60AC IOL, and eyes in group 2 (n = 30) received the acrylic hydrophilic XLSTABI IOL. Optical aberrations were measured with Nidek OPD-Scan at least 1 month after cataract surgery for a 6.0 mm pupil diameter using a 6th-order Zernike polynomials decomposition. RESULTS: In group 1, the mean root-mean-square (RMS) coefficient for the total higher aberration was 0.86 microm +/- 0.38 (SD). The mean RMS of the tilt, coma, trefoil, tetrafoil, spherical aberration, and secondary astigmatism was 0.81 +/- 0.45 microm, 0.38 +/- 0.30 microm, 0.55 +/- 0.18 microm, 0.13 +/- 0.23 microm, 0.30 +/- 0.13 microm, and 0.17 +/- 0.21 microm, respectively. In group 2, the mean RMS coefficient for the total higher aberration was 0.72 +/- 0.31 microm. The mean RMS of the tilt, coma, trefoil, tetrafoil, spherical aberration, and secondary astigmatism was 0.55 +/- 0.30 microm, 0.24 +/- 0.19 microm, 0.50 +/- 0.23 microm, 0.07 +/- 0.22 microm, 0.32 +/- 0.13 microm, and 0.14 +/- 0.14 microm, respectively. There was a statistical difference in aberrations between the 2 groups for the tilt and the coma aberrations (P<.05). There were more aberrations in the MA60AC IOL group. CONCLUSIONS: The design of the IOL influenced ocular aberrations after cataract surgery. There were more tilt and coma aberrations in the MA60AC IOL group.

Takayasu disease revealed by bilateral loss of vision.

PURPOSE: Takayasu arteritis is a nonspecific granulomatous inflammatory arteriopathy of unknown cause, most frequently diagnosed in young Asian women. The authors present an atypical initial presentation of Takayasu disease with bilateral loss of vision in a young Haitian man. METHODS: Case report. RESULTS: The presenting feature was bilateral loss of vision, a result of malignant hypertensive retinopathy and choroidopathy. Systemic evaluation disclosed inflammatory signs and renal artery obstruction which caused the malignant hypertension. CONCLUSION: This case, involving an unusual presentation of Takayasu disease, illustrates how a malignant hypertensive retinopathy and choroidopathy led to the ultimate diagnosis of Takayasu disease.