Céline Faure

Functional and high resolution retinal imaging assessment in a case of ocular siderosis

AbstractPurpose To report new findings in a case of ocular siderosis explored by high resolution angiography and adaptive optics (AO).Methods We report data on a 40-year-old man with an intraocular foreign body (IOFB) embedded in the sclera after hammering.Results Nine months after this accident, the patient presented with full-field electroretinogram (FF-ERG) abnormalities. Subsequent IOFB extraction was performed. One month after the surgery, high resolution angiography showed for the first time small iron particles all over the inner retinal surface. Spreading of these deposits was followed by inflammatory prepapillary new vessels and venous retinal vasculatis, which spontaneously resolved within a few months. ERG responses became slightly electronegative at this time. Clearance of the iron particles was followed over a year with AO and ERG recording. AO revealed an arterial tropism with a decrease in the amount of particles overtime, which may be consistent with macrophagic activity.Conclusion High resolution angiography and AO are new tools, combined with electrophysiology, to better understand ocular siderosis pathophysiology.

Asymptomatic atrophy of the temporal median raphe of the retina associated with cerebral vasculopathy in homozygous sickle cell disease

A 13-year-old girl with homozygous sickle cell disease was referred for vision loss in her left eye of 1 years duration. Clinical findings were consistent with a past retinal arterial occlusion. In the asymptomatic right eye, spectral domain optical coherence tomography showed a severe atrophy of the inner retinal layers of the temporal median raphe; a significant internal carotid stenosis was also present. We hypothesize that specific atrophy of the retinal temporal median raphe resulted from chronic ischemia. The inner layers of the retina are vascularized by terminal vessels and the median raphe can therefore be regarded as a junction territory; its atrophy may represent an ocular equivalent of a silent border zone cerebral infarct.

Interaction study between rtPA and bevacizumab

We read with great interest the article by Treumer et al in the January 2010 issue of the journal, regarding the dual action of subretinal injection of recombinant tissue plasminogen activator (rtPA) and bevacizumab associated with pneumatic displacement in treating submacular haemorrhage secondary to age-related macular degeneration.1 Injecting both bevacizumab and rtPA in subretinal,2 or in intravitreal use,3–5 serves the purpose of treating both the subretinal haemorrhage and neovascularisation. However, rtPA is a serine protease with its catalytic …

Hypertonie oculaire aiguë tardive compliquant une rétinopathie de la prématurité

Retinopathy of prematurity complicated by late glaucoma: a case report C. Faure, G. Caputo, J.-A. Sahel, M. Paques. Introduction: We report the case of an acute rise in intraocular pressure occurring decades after the treatment for prematurity (ROP). Case report: A 54-year-old preterm woman presented an acute rise in intraocular pressure in her right amblyopic eye. Prominent dilatation of iridal vessels was noted. Fundus was not visible at that time because of corneal edema. Ocular echography was normal. The fellow eye showed temporal attraction of temporal vessels suggestive of retinopathy of prematurity at the cicatricial stage. Neovascular glaucoma was postulated and pressure control was obtained after cyclodestruction and transscleral cryoapplication. After resolution of corneal edema, fundus examination revealed extensive peripheral retinal photocoagulation scars. Iridocorneal angle presented extensive iridocorneal synechias without true new vessels. Visual acuity remained limited to hand motion. Conclusion: Prominent iris dilatation seen in some preterm patients can mimic rubeosis, and, in the present case, mislead to a diagnosis of neovascular glaucoma. Diagnosis can be difficult if the patient is not specifically asked for a history of prematurity. The case underlines the notion that ROP patients may present very late complications of the disease.

302 Néovascularisation choroïdienne associée ou non à un hématome sous rétinien. Action combinée du Bevacizumab-rtPA et déplacement pneumatique : à propos de 19 cas

Introduction La prise en charge des neovaisseaux choroidiens a ete transformee par l’arrivee des anti-VEGF. Cependant, la survenue d’un hematome sous retinien reste un evenement de mauvais pronostic. Differentes techniques de drainage associant ou non le rtPA ont ete decrites. Ces methodes donnaient des resultats variables sans traiter la cause du saignement. Materiels et Methodes La serie comprend 19 patients (2 hemorragies sous retiniennes sur vasculopathies polypoidales, 4 sur neo vaisseaux visibles, 9 sur occultes et 4 patients presentant des DMLA evoluees fibrotiques) operes par vitrectomie, injection sous retinienne associant Bevacizumab-rtPA et deplacement pneumatique. La justification de la co-administration repose sur la volonte de traiter l’hemorragie sous retinienne et la neo vascularisation dans le meme temps. Resultats L’acuite visuelle moyenne preoperatoire etait de 1,24 log MAR (± 0,41). L’acuite visuelle moyenne postoperatoire etait de 1,15 log MAR (± 0,52). Le delta moyen des acuites visuelles etait de – 0,08 log MAR (± 0,46). Les resultats different en fonction du type de neo vascularisation initialement traitee et du caractere fibrotique de la plage hematique sous-retinienne. Discussion Lors de l’angiogenese, le reseau neoforme perd sa dependance vis-a-vis du VEGF des lors que les pericytes forment un manchon autour du tube constitue des cellules endotheliales. A un stade plus evolue, cette trame se transforme en tissu fibreux qui peut persister. Les anti-VEGF sont inefficaces pour induire la regression neo vasculaire a ce stade. L’utilisation simultanee du rtPA semble efficace pour destabiliser la partie mature du reseau neo vasculaire en degradant la matrice extracellulaire. Nous postulons que la partie du neo vaisseau qui etait independante de l’action du VEGF redevient sensible a cette action et par la meme sensible a un traitement anti-VEGF. Conclusion Cette technique donne des resultats encourageants pour traiter les hemorragies sous retiniennes recentes soit sur neovaisseaux visibles, sur vasculopathies polypoidales ou sur neovaisseaux occultes sans decollement de l’epithelium pigmentaire trop important ou irregulier.