A. Lecleire-Collet

Dome-Shaped Macula in Eyes with Myopic Posterior Staphyloma

PURPOSE To describe an unusual feature in myopic eyes responsible for visual loss, which we call a dome-shaped macula. DESIGN Retrospective, observational case series. METHODS After observing isolated cases of dome-shaped macula, we analyzed optical coherence tomography (OCT) scans of 140 highly myopic eyes present in our OCT database to find similar cases. Fifteen eyes of 10 patients had a dome-shaped macula. These patients all had undergone fluorescein angiography (FA), indocyanine green angiography (ICGA), and B-scan ultrasonography examinations. RESULTS The mean refractive error of the affected eyes was -8.25 diopters (D; range, -2 to -15 D). Median visual acuity was 20/50. Recent visual impairment was noted in 11 of the 15 eyes studied, and metamorphopsia was noted in eight eyes. Four eyes were asymptomatic. FA showed atrophic changes in the macular retinal pigment epithelium (RPE) in all eyes, combined with focal points of leakage in seven of the 15 eyes. The dome-shaped appearance of the macula was visible on both B-scan ultrasonography and OCT: a characteristic bulge of the macular retina, RPE, and choroid within the concavity of the moderate posterior staphyloma was present in all eyes. In 10 eyes, OCT also showed a shallow foveal detachment at the top of the dome-shaped macula. CONCLUSIONS A dome-shaped macula within a myopic staphyloma is an unreported type of myopic posterior staphyloma. The dome-shaped macula often is associated with RPE atrophic changes and foveal retinal detachment, which may explain the visual impairment in these eyes.

Classification simplifiée de la rétinopathie diabétique adaptée au dépistage par photographies du fond d’œil

Objectifs Les photographies du fond d’œil realisees avec un retinographe non mydriatique constituent la methode de reference pour le depistage de la retinopathie diabetique. L’objectif de cette etude est de valider une classification simplifiee de la retinopathie diabetique, adaptee au depistage par photographies du fond d’œil. Patients et methode Cent vingt et un patients diabetiques ont eu trois photographies couleur du fond d’œil, analysees par quatre lecteurs differents selon la classification de depistage proposee, ainsi qu’un examen de reference (panoramique des 9 champs et examen tomographique par coherence optique de la macula). Resultats La classification de depistage proposee etait simple a utiliser car elle reposait sur la comparaison visuelle des trois photographies du fond d’œil avec des photographies standard. Elle a permis de diagnostiquer les stades severes de retinopathie diabetique avec une sensibilite de 100 % et une specificite de 50 a 58 % lorsque l’examen de depistage mettait en evidence une retinopathie non proliferante moderee ou plus grave. Elle a egalement permis de diagnostiquer un œdeme maculaire avec une sensibilite de 96 a 97 % et une specificite de 89 a 91 %. De plus, les resultats de l’examen de depistage selon cette classification etaient tres reproductibles (concordance inter-lecteur : kappa pondere = 0,78-0,93). Conclusion Cette etude confirme la fiabilite de la classification simplifiee proposee. Le stade seuil de retinopathie diabetique au-dessus duquel cette strategie de depistage n’est plus valable est celui de retinopathie diabetique non proliferante minime. Ainsi, a partir du stade de retinopathie non proliferante moderee mis en evidence sur l’examen de depistage, un examen de la totalite du fond d’œil est recommande. Les formes severes doivent etre prises en charge sans delai par l’ophtalmologiste.

Spontaneous resolution of macular edema after panretinal photocoagulation in florid proliferative diabetic retinopathy.

Purpose: To report the evolution of diabetic macular edema (DME) after extensive panretinal photocoagulation in patients with Type 1 diabetes exhibiting florid proliferative diabetic retinopathy (FPDR). Methods: This retrospective observational case series comprised 17 eyes of 10 consecutive patients (8 women and 2 men). All patients exhibited FPDR combined with severe DME, and all underwent panretinal photocoagulation. The evolution of visual acuity and progression of FPDR were evaluated. The evolution of DME during follow-up was assessed by fluorescein angiography and repeated optical coherence tomography examinations. Results: At baseline, all eyes had diffuse DME. Mean logMAR visual acuity was 0.402 ± 0.46. Mean central macular thickness was 468.23 ± 113.63 &mgr;m. After panretinal photocoagulation, DME regressed spontaneously in all eyes after a mean follow-up of 7.1 ± 2.68 months. Mean central macular thickness decreased to 268.12 ±54.67 &mgr;m (t-test, P < 0.0001). Mean visual acuity improved significantly to 0.184 ± 0.12 (t-test, P = 0.048). Diabetic macular edema only recurred in two eyes. Conclusion: In DME combined with FPDR, extensive panretinal photocoagulation and glycemic control seem effective in reducing DME and improving vision. In FPDR, DME may be caused by excessive production of vascular endothelial growth factor by the unperfused retina.

Retinal ischaemia in type 1 neurofibromatosis

Systemic occlusive arteriopathy associated with type 1 neurofibromatosis (NF-1) has been well described in the aortic and cerebral vasculature1; however, it is poorly documented in the retinal vasculature with, to our knowledge, only three reported patients whose retinal vasculopathy was diagnosed at a later sequelae stage.2–4 We report the case of a young woman with NF-1 who presented with acute macular ischaemia combined with diffuse retinal arterial occlusive disease. A 26 year old woman with NF-1 presented with a sudden painless loss of vision in her left eye. Visual acuity was counting fingers left eye and 20/20 right eye. NF-1 had previously been diagnosed on the basis of multiple cafe au lait spots, plexiform neurofibromas, and a paternal history of NF-1. Left fundus …

Nouvelles techniques d’imagerie de la rétine

La degenerescence maculaire liee a l’âge (DMLA) represente aujourd’hui la premiere cause de cecite des personnes âgees dans les pays occidentaux. Aujourd’hui, nous avons la possibilite de realiser des observations de la retine in vivo qui permettent une meilleure evaluation des maladies retiniennes et aussi de la DMLA. Cet article recense l’ensemble des techniques d’imagerie les plus recentes (incluant la tomographie en coherence optique, l’autofluorescence du fond d’œil, l’analyse de diametre des vaisseaux retiniens, l’imagerie a haute resolution a l’aide de l’optique adaptative). Les principes ainsi que les caracteristiques d’imagerie y sont decrits. La description des avantages potentiels dont pourra beneficier le medecin dans son travail clinique quotidien, mais aussi certains aspects des futures recherches sur la DMLA y sont presentes.