Corinne Delahaye-Mazza

Results of one-year's treatment with ranibizumab for exudative age-related macular degeneration in a clinical setting.

PURPOSE To evaluate the results of 1 year of treatment with intravitreal ranibizumab for exudative age-related macular degeneration (AMD) in a clinical setting. DESIGN Nonrandomized, single-center, retrospective, interventional case series. METHODS Retrospective analysis of consecutive charts and angiograms of patients with previously untreated exudative AMD, treated in one or both eyes with ranibizumab between January 2 and October 31, 2007. The following were recorded for each patient: age at presentation, gender, treated eye, type of choroidal neovascularization, visual acuity (VA) measured on an Early Treatment Diabetic Retinopathy Study chart at baseline and at 52 +/- 6 weeks, the number of performed intravitreal (IVT) injections, and follow-up examinations. RESULTS The 122 patients comprised 85 women (70%) and 37 men ranging in age from 56 to 91 years (mean +/- standard deviation, 78.3 +/- 7). In all, 124 eyes were treated on a pro re nata basis after 1 or 3 initial IVT injections. The mean number of IVT injections was 3.79 +/- 1.39 (range, 1 to 7). The mean number of follow-up visits was 8.07 +/- 1.44 (range, 4 to 12). Mean VA +/- standard deviation changed from 56.15 +/- 14 to 56.89 +/- 17 letters (VA gain, +0.7 letters). CONCLUSIONS The results showed that VA stabilized rather than improved and compared unfavorably with the gains found in randomized clinical trials and the Prospective Optical Coherence Tomography Imaging of Patients with Neovascular AMD Treated with intraOcular Ranibizumab (PrONTO) Study. However in this study, patients were examined less frequently and were treated far less frequently. The present results suggest that a long, regular follow-up is necessary for patients treated with ranibizumab to obtain and preserve significant visual gain, and not only to achieve visual stabilization.

Visual hallucinations immediately after macular photocoagulation

PURPOSE To evaluate the incidence of visual hallucinations after macular photocoagulation for choroidal neovascularization. METHODS After macular photocoagulation for choroidal neovascularization, 60 consecutive patients were asked to respond to an orally administered questionnaire. RESULTS Twenty-seven patients (45%) described photopsias, flashing lights of various colors. Ten additional patients (16.6%) also described structured hallucinations, including known or unknown faces, flowers, and geometric patterns, which occurred hours or a few days after photocoagulation. Patients with structured hallucinations were older (P =.04) and more often had subfoveal choroidal neovascularization (P =.005) and severe macular disease in both eyes or at least in the treated eye (P =.01). CONCLUSIONS Visual hallucinations appear to be a frequent, albeit unrecognized, side effect of macular photocoagulation of choroidal neovascularization. The provision of proper information to patients may avoid concern about a psychiatric origin of their hallucinations.

Intravitreal Ranibizumab and/or Dexamethasone Implant for Macular Edema Secondary to Retinal Vein Occlusion

Purpose: To investigate the outcome of intravitreal ranibizumab and/or dexamethasone implant treatment for treatment of macular edema (ME) secondary to central or branch retinal vein occlusion (CRVO or BRVO) in a clinical setting. Methods: Retrospective analysis of consecutive patients followed for at least 6 months. Data recorded included the type of occlusion, initial and final visual acuity, and number of injections. Results: Sixty-five patients were included, 26 had CRVO and 39 BRVO. Mean (±SD) follow-up duration was 16 (±7.7) months. Twenty-four (36.9%) patients received ranibizumab in monotherapy, 19 patients (29.3%) dexamethasone in monotherapy, and 22 patients (33.8%) received successively both treatments. In dexamethasone-treated patients, mean (±SD) visual acuity gain was 5.8 ± 10.7 letters for BRVO and 16.8 ± 15.6 letters for CRVO. In ranibizumab-treated patients, mean (±SD) visual acuity gain was 9.2 ± 10 letters for BRVO and 18.2 ± 20.5 letters for CRVO. Conclusion: Both intravitreal ranibizumab and dexamethasone intravitreal implant could be used as first-line therapy for patients with ME secondary to retinal vein occlusion.

Bimonthly Ranibizumab for Neovascular Age-Related Macular Degeneration

Background/Purpose: Recently, aflibercept was proposed with a protocol of a bimonthly fixed regimen. Our purpose was to evaluate the results of this regimen in patients treated with ranibizumab. Method: We conducted a retrospective analysis of consecutive patients with naïve neovascular age-related macular degeneration treated with a bimonthly fixed regimen of intravitreal injections of ranibizumab after 3 monthly injections. Examination was performed every 4 weeks for 52 weeks, with the possibility of unscheduled rescue injections of ranibizumab. Results: A total of 27 patients, 24 women and 3 men, aged from 68 to 90 years (mean: 81.2) were analyzed; 25 eyes (92.5%) lost <15 letters. Mean BCVA rose from 58.3 (range ± 12.9) to 66.7 (range ± 14.3) letters. The mean visual gain was 8.40 (range ± 13.2) letters; 11 patients (40.7%) gained ≥15 letters. The mean number of injections of ranibizumab was 8.77. Conclusion: Bimonthly intravitreal ranibizumab achieved satisfactory visual results. However, patients who required additional injections did not experience significant visual gain.

Spectral domain optical coherence tomography analysis of macular changes in tilted disk syndrome.

Purpose: To evaluate the prevalence of macular complications in tilted disk syndrome by spectral domain optical coherence tomography (OCT). Methods: A monocentric retrospective study of consecutive patients with tilted disk syndrome, whose eyes were examined by spectral domain OCT (Cirrus; Zeiss) and fundus photography. Results: Fifty consecutive patients (39 women and 11 men; age range, 41–96 years) with uni- or bilateral tilted disk syndrome were enrolled. All affected eyes (n = 92) were imaged by spectral domain OCT and fundus photography. Fluorescein and/or indocyanine green angiography were performed in 33 patients (66%). Macular anomalies or complications were observed in 71 eyes (77.1%). Specifically, retinal pigment epithelial changes were described in 34 eyes (36.9%), choroidal neovascularization in 24 eyes (26%), and macular serous retinal detachment in 16 eyes (17.3%). Epiretinal membrane in 9 eyes (9.7%), myopic foveoschisis in 5 eyes (5.4%), and lamellar macular hole in 3 eyes (3.2%) were also detected relatively frequently by spectral domain OCT. Surprisingly, fovea plana was observed in 5 eyes (5.4%). Eleven eyes, complicated by choroidal neovascularization, were treated with ranibizumab, with a mean visual gain of 7.9 letters on Early Treatment Diabetic Retinopathy Study chart. Conclusion: Tilted disk syndrome can be associated with potentially severe macular complications. Spectral domain OCT allowed the recognition of additional macular changes associated with tilted disk syndrome, such as epiretinal membranes, myopic foveoschisis, and fovea plana.

BRIDGE ARCH-SHAPED SEROUS RETINAL DETACHMENT IN AGE-RELATED MACULAR DEGENERATION.

Purpose: To describe bridge arch-shaped serous retinal detachment (SRD) in exudative age-related macular degeneration and evaluate its functional outcomes. Methods: In this monocentric, retrospective, noncomparative case series, patients were included. Patients with exudative age-related macular degeneration and bridge arch-shaped SRD treated with ranibizumab were included. Anatomical patterns of SRD and functional outcomes were assessed. Results: Twenty-two eyes with bridge arch-shaped SRD of 22 patients with age-related macular degeneration were included. Serous retinal detachments were characterized by a steep angle at the junction between the retinal pigment epithelium and the sensory retina (mean, 53.45 ± 12.5°), and characterized by the presence of adhesion areas between the sensory retina and a fibrous complex developed from the choroidal neovascularization. In 15 eyes, the choroidal neovascularization was classic choroidal neovascularization and a fibrotic evolution was observed. Serous retinal detachments were compartmentalized in 14 eyes, leading to a multipocket structure. Visual acuity decreased from 49.9 ± 19.2 letters (20/100) to 40.3 ± 18.6 letters (20/160), corresponding to a mean change of −9.6 ± 19.4 letters. Conclusion: This was the first study to describe the specific morphologic features of bridge arch-shaped SRD, a previously undescribed type of SRD complicating exudative age-related macular degeneration. Patients with bridge arch-shaped SRD responded to intravitreal injections of ranibizumab, but their visual prognosis was unfavorable, compared with the literature. The presence of bridge arch-shaped SRD seemed to be a marker for the fibrotic evolution of the choroidal neovascularization.

Optical Coherence Tomography Angiography of Familial Retinal Arteriolar Tortuosity

BACKGROUND AND OBJECTIVE To analyze the location of familial retinal arterial tortuosity (fRAT) in the three-dimensional structure of retinal capillaries. PATIENTS AND METHODS Retrospective observational study. Twelve eyes of six patients (two of whom were brothers) were imaged by optical coherence tomography angiography (OCTA). The data from their ocular and systemic examinations were recorded. RESULTS OCTA imaging clearly showed increased tortuosity of second- and third-order retinal arteries in all cases, visible in the superficial vascular plexus (SVP) up to the arteriole termination in the capillaries. No change was visible in the deep capillary plexus (DCP). CONCLUSIONS OCTA shows that fRAT affects all the course of the arterioles up to the capillaries in the SVP. The DCP does not show arteriolar tortuosity because it does not contain arterioles. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:397-401.].

Treatment Efficacy and Compliance in Patients with Diabetic Macular Edema Treated with Ranibizumab in a Real-Life Setting

Purpose To assess real-life efficacy of ranibizumab and treatment compliance of patients with vision loss secondary to diabetic macular edema (DME). Methods A retrospective study was conducted in DME patients treated with ranibizumab. Patients were monitored every 4 weeks for visual acuity (VA) and central retinal thickness (CRT) by SD-OCT. All patients received a loading dose of 3 monthly injections followed by retreatments on an as-needed basis. The primary endpoint was the change in VA at M12. Patient compliance to the follow-up and the correlation between the injection number and VA were also investigated. Compliance was compared to that of neovascular age-related macular degeneration (nAMD) patients. Results Seventy-two eyes of 55 consecutive DME patients were included. At baseline, the mean VA was 56.5 letters and CRT was 470 μm. At M12, the mean VA was 63.4 letters (p < 0.0001), 31.1% of patients had a VA > 70 letters, the mean VA change was +6.9 letters, and the mean CRT was 361.9 μm (p = 0.0001) after a mean number of 5.33 intravitreal injections. In patients who received ≥7 injections, the VA gain and final VA were significantly higher than in patients who received <7 injections. At M12, 25.45% of DME patients were lost to follow-up versus 16.8% of nAMD patients (n = 55). Discussion/Conclusion Our study confirms the real-life efficacy of ranibizumab in DME at M12 and the need for a large number of injections to achieve better visual outcomes. We also showed a trend to a lower compliance in diabetic versus nAMD patients.

Impact of ranibizumab on visual impairment in patients with bilateral diabetic macular edema

AimsDiabetic macular edema (DME) frequently presents bilaterally. In case of bilateral retinal disease, the visual impairment (VI) and the visual acuity (VA) are strongly correlated to the better eye. The aim of this study was to assess the impact of ranibizumab intravitreal injections (IVR) on VI in patients with simultaneous VA loss due to DME.MethodsThis was a retrospective two-center study including consecutive DME patients with visual loss treated with ranibizumab since November 2011 and with a minimum follow-up of 6 months. Patients with bilateral visual decrease from DME undergoing IVR within 6 months of each other were included.ResultsTwenty-nine DME patients who received bilateral IVR within a 6-month interval in the second eye were included. At baseline, 82.8% (n = 24) of patients had a VA < 20/40 in their better eye versus 44.8% (n = 13) of patients at the end of follow-up, i.e. a reduction by 45.9% of VI. In the better eye, the mean VA was 57.3, 65.0 and 65.5 ETDRS letters, respectively, at baseline, month 3 and month 6 (mean VA gain +8.2 letters). In the worse eye, the mean VA was 44.2, 53.5 and 53.8 ETDRS letters, respectively, at baseline, M3 and M6 (mean VA gain +9.6 letters).ConclusionsIn patients with bilateral DME, subsequent ranibizumab IVR reduced VI frequency.

PERIPAPILLARY RETINAL PIGMENT EPITHELIUM CHANGES IN AGE-RELATED MACULAR DEGENERATION.

Purpose: To describe peripapillary retinal pigment epithelium changes observed in patients with age-related macular degeneration (AMD) and evaluate their prevalence. Methods: This study is a prospective, monocentric, comparative case series including 104 consecutive patients with AMD, and 34 patients who are more than 60 years old and consulting for other conditions (control group). Color and fundus autofluorescence images centered on the optic disk were taken and graded by 2 independent readers from 0 to 4: 0, absent; 1, uneven background; 2, focal hyperautofluorescent dots and spots; 3, light reticular pattern; 4, dense reticular pattern. Statistical analysis was performed to correlate the presence of peripapillary retinal pigment epithelium changes with age, sex, and AMD subtype. Results: Peripapillary retinal pigment epithelium changes were observed in 76/104 AMD eyes (73.0%) and were significantly more frequent than in eyes with other conditions (14/34, 41.1%, P = 0.002), whereas groups did not differ for age (P = 0.14). Grade ≥2 peripapillary retinal pigment epithelium changes were more frequently observed in patients with AMD than in controls (41.3 vs. 17.6%, P = 0.013). No differences were found between patients with AMD having peripapillary retinal pigment epithelium changes and other patients for age distribution (P = 0.14), sex ratio (P = 0.34), or AMD type (P = 0.57). Conclusion: Peripapillary retinal pigment epithelium changes were more frequent in patients with AMD than in controls, and when present, they were of higher grade. Peripapillary retinal pigment epithelium changes significance is not yet understood and needs further evaluation.