Bénédicte Dupas

Subfoveal Deposits Secondary to Idiopathic Epiretinal Membranes

PURPOSEnTo describe the subfoveal deposits secondary to idiopathic epiretinal membranes (ERMs) and to assess their effect on the preoperative and postoperative course.nnnDESIGNnRetrospective, observational case series.nnnPARTICIPANTSnOne hundred patients operated on consecutively for idiopathic ERMs in a single center.nnnMETHODSnThe files of 100 consecutive patients operated on for idiopathic ERMs were reviewed by 2 independent investigators. Fellow eyes were used as matched controls. Patients with an ERM in the contralateral eye were excluded, as well as those with no available fundus photographs or optical coherence tomography (OCT) scans. In all, 87 eyes were included in the study.nnnMAIN OUTCOME MEASURESnComparison of subfoveal deposit frequency in eyes with an ERM and their fellow eyes, as shown by Stratus OCT scans and fundus photographs, and preoperative and postoperative best-corrected visual acuity (VA) in eyes with an ERM.nnnRESULTSnA subfoveal deposit was found on both preoperative fundus photographs and OCT scans in 15 eyes with an ERM (17.2%) versus 5 (5.7%) in control fellow eyes (P = 0.0303). The group of patients with a subfoveal deposit was 5.3 years older, on average, than the group without (P = 0.0206). Time of onset of ERMs and macular thickness were not different between the 2 groups (P = 0.5663 and P = 0.7488, respectively). There was no significant difference regarding gender ratio or mean preoperative and postoperative VA (P = 0.9498 and P = 0.9902, respectively).nnnCONCLUSIONSnIn this series, subfoveal deposits seemed to be associated with the presence of ERMs. Interestingly, they did not preclude good postoperative VA.nnnFINANCIAL DISCLOSURE(S)nThe author(s) have no proprietary or commercial interest in any materials discussed in this article.

Association Between Vessel Density and Visual Acuity in Patients With Diabetic Retinopathy and Poorly Controlled Type 1 Diabetes

Importance Capillary dropout is a hallmark of diabetic retinopathy, but its role in visual loss remains unclear. Objective To examine how macular vessel density is correlated with visual acuity (VA) in patients younger than 40 years who have type 1 diabetes without macular edema but who have diabetic retinopathy requiring panretinal photocoagulation. Design, Settings, and Participants Retrospective cohort study of VA and optical coherence tomography angiography data collected from consecutive patients during a single visit to Lariboisière Hospital, a tertiary referral center in Paris, France. The cohort included 22 eyes of 22 patients with type 1 diabetes without macular edema but with bilateral rapidly progressive diabetic retinopathy that was treated with panretinal photocoagulation between August 15, 2015, and December 30, 2016. Eyes were classified into 2 groups by VA: normal (logMAR, 0; Snellen equivalent, 20/20) and decreased (logMAR, >0; Snellen equivalent, <20/20). The control group included 12 eyes from age-matched healthy participants with normal vision. Main Outcomes and Measures Visual acuity and mean vessel density in 4 retinal vascular plexuses: the superficial vascular plexus and the deep capillary complex, which comprises the intermediate capillary plexus and the deep capillary plexus. Results Of the 22 participants, 11 (50%) were men, mean (SD) age was 30 (6) years, and mean (SD) hemoglobin A1c level was 8.9% (1.6%). Of the 22 eyes with diabetic retinopathy, 13 (59%) had normal VA and 9 (41%) had decreased VA (mean [SD]: logMAR, 0.12 [0.04]; Snellen equivalent, 20/25). Mean [SE] vessel density was lower for eyes with diabetic retinopathy and normal VA compared with the control group in the superficial vascular plexus (44.1% [0.9%] vs 49.1% [0.9%]; difference, −5.0% [1.3%]; 95% CI, −7.5% to −2.4%; Pu2009<u2009.001), in the deep capillary complex (44.3% [1.2%] vs 50.6% [1.3%]; difference, −6.3% [1.8%]; 95% CI, −9.9% to −2.7%; Pu2009=u2009.001), in the intermediate capillary plexus (43.8% [1.2%] vs 49.3% [1.2%]; difference, −5.5% [1.7%]; 95% CI, −9.0% to −2.0%; Pu2009=u2009.003), and in the deep capillary plexus (24.5% [1.0%] vs 30.5% [1.0%]; difference, −6.1% [1.4%]; 95% CI, −8.9% to −3.2%; Pu2009<u2009.001). Mean vessel density was lower in eyes with diabetic retinopathy and decreased VA compared with eyes with diabetic retinopathy and normal VA; the mean (SE) loss was more pronounced in the deep capillary complex (34.6% [1.5%] vs 44.3% [1.2%]; difference, −9.6% [1.9%]; 95% CI, −13.6% to −5.7%; Pu2009<u2009.001), especially in the deep capillary plexus (15.2% [1.2%] vs 24.5% [1.0%]; difference, −9.3% [1.5%]; 95% CI, −12.4% to −6.1%; Pu2009<u2009.001), than in the superficial vascular plexus (39.6% [1.1%] vs 44.1% [0.9%]; difference, −4.5% [1.4%]; 95% CI, −7.3% to −1.7%; Pu2009=u2009.002). Conclusions and Relevance These data suggest that in patients with type 1 diabetes without macular edema but with severe nonproliferative or proliferative diabetic retinopathy, decreased VA may be associated with the degree of capillary loss in the deep capillary complex.

Indocyanine-green-guided targeted laser photocoagulation of capillary macroaneurysms in macular oedema: a pilot study

Aims In longstanding diabetic macular oedema (DME) or retinal vein occlusion (RVO), capillary macroaneurysms may develop. Indocyanine green angiography (ICGA) has been shown to optimise their detection. Here, we report the anatomical and functional outcome of the elective photocoagulation of capillary macroaneurysms. Methods A retrospective, interventional, two-centre study. In eyes with chronic macular oedema and severe hard exsudates due to diabetic retinopathy or RVO, the presence of capillary macroaneurysms (defined by a diameter larger than 150u2005µm) was assessed by ICGA and optical coherence tomography (OCT). Capillary macroaneurysms were selectively photocoagulated, the presence of photothrombosis within the lumen being assessed by immediate OCT. Results Four eyes from three patients with DME and five eyes from five patients with RVO were included. The median duration of visual loss was 4u2005years. Median initial visual acuity (VA) was 20/200. The median number of capillary macroaneurysms per eye was 2 (range, 1–8) and their median size was 410u2005µm (range, 154–603). Six months after photocoagulation, there was a significant reduction in macular thickness (mean±SD, 528u2005µm±200 vs 271u2005µm±152, p<0.05) and improvement of VA (mean log MAR, 0.82 vs 0.58, p<0.05). Conclusions During macular oedema with severe hard exsudates due to DME or RVO, systematic detection of capillary macroaneurysms by ICGA followed by their OCT-controlled photocoagulation may be of interest. These results may contribute to re-evaluate the role of photocoagulation in the management of longstanding macular oedema.

Evolution of Subfoveal Detachments Secondary to Idiopathic Epiretinal Membranes after Surgery.

PURPOSEnTo study the characteristics of subfoveal abnormalities secondary to idiopathic epiretinal membranes (ERM) using improved-resolution spectral-domain optical coherence tomography (SD OCT) and their evolution after surgery.nnnDESIGNnRetrospective, observational cohort study.nnnPARTICIPANTSnThe files of 344 patients operated on consecutively for ERM over a 2-year period in a single tertiary ophthalmologic center were reviewed. Patients with vitreomacular traction syndrome, secondary ERM, or both were excluded.nnnMETHODSnIn all, 293 eyes with idiopathic ERM were included in the final analysis. Fundus photographs were reviewed to assess the presence of a yellow foveal spot, and SD OCT analysis was performed.nnnMAIN OUTCOME MEASURESnPresence or absence of a subfoveal abnormality and its SD OCT characteristics before and after surgery at 1 month, 3 months, and at final visit; best-corrected visual acuity (BCVA) and central macular thickness at baseline, 1 month, 3 months, and at the final visit.nnnRESULTSnBefore surgery, a subfoveal detachment (SD) corresponding to the yellow deposit was present in 59 of 293 eyes (20%). No difference was found for the postoperative BCVA between the 59 eyes with SD before surgery and the 234 eyes without SD (0.253 ± 0.14 logarithm of the minimum angle of resolution [logMAR] vs. 0.262 ± 0.24 logMAR, respectively; P = 0.6). Sixty-eight percent (n = 40/59) of SD disappeared after surgery during a mean follow-up of 4.8 ± 3.2 months, most of them (62%) before month 3. Among eyes with preoperative SD, no difference was found for the postoperative BCVA between eyes with disappeared SD and those with persistent SD.nnnCONCLUSIONSnSubfoveal detachments secondary to idiopathic ERM were observed in 20% of these eyes. They disappeared after surgery in more than two thirds of cases, usually early during postoperative course. Subfoveal detachments do not affect visual outcome and should not interfere with surgical decision making.

Les membranes épirétiniennes maculaires

Idiopathic epiretinal membranes represent a common condition, and are present in approximately 10% of people over the age of 70 years. They are idiopathic in 80% of cases, or may be secondary to various conditions such as a prior retinal detachment, or vascular or inflammatory retinal diseases. The main symptoms are visual loss and metamorphopsia. The diagnosis of epiretinal membrane is currently facilitated by OCT, which provides prognostic and therapeutic decision-making assistance. Surgery for epiretinal membranes is currently well codified through sutureless vitrectomy and dyes. Dissection of the membrane (with or without associated peeling of the internal limiting membrane) ensures good anatomical and functional results, while being relatively minimally invasive.

457 Ostéome choroïdien bilatéral avec néo vaisseaux choroïdiens traités par Bevacizumab

Introduction Nous rapportons le cas d’un patient de 17 ans d’origine antillaise presentant un osteome choroidien bilateral decouvert lors de l’apparition brutale de neo vaisseaux choroidiens des deux cotes. Materiels et Methodes L’acuite visuelle initiale etait de 5/10 P6 a droite et de 1/20 P14 a gauche. Une seule injection intra vitreenne de Bevacizumab a ete realisee aux deux yeux. Resultats Ces injections ont permis une amelioration anatomique et fonctionnelle importante. Il n’y a pas de rechute apres 6 mois de suivi. L’acuite visuelle est remontee a 10/10 P2 a droite et a 7/10 P2 a gauche. Discussion Les neo vaisseaux choroidiens sont une complication frequente des osteomes. 47 % des patients presentent cette complication apres 10 ans de suivi. Les osteomes ne sont bilateraux que dans 25 % des cas. Une neo vascularisation choroidienne bilaterale simultanee est exceptionnelle. Le Bevacizumab montre ici, comme dans d’autres cas de neo vascularisation choroidienne du sujet jeune, son efficacite avec une injection unique. Conclusion La neo vascularisation choroidienne est une complication non specifique qui emaille l’evolution des osteomes choroidiens et entraine une perte de vision prematuree. Un traitement intra-oculaire anti angiogenique se revele extremement efficace pour faire regresser de facon durable les neo vaisseaux, permettant une amelioration visuelle malgre la presence de l’osteome.