F. De Bats

Bevacizumab versus ranibizumab in the treatment of exudative age-related macular degeneration: A retrospective study of 58 patients

AIM To compare the efficacy and safety of bevacizumab versus ranibizumab in the treatment of patients with neovascular age-related macular degeneration (AMD). PATIENTS AND METHODS Retrospective case-controlled series of 30 patients treated with intravitreal bevacizumab and 28 patients treated with intravitreal ranibizumab for exudative AMD. Main outcomes measured included best-corrected visual acuity (BCVA), central macular thickness (CMT) and foveal thickness, quantity of subretinal fluid, neovessel size and total number of injections over the first year treatment period. A secondary outcome was the report of any adverse events in both groups. RESULTS BCVA stabilized and increased from LogMAR 0.70 to 0.47 in the bevacizumab group and from 0.55 to 0.54 in the ranibizumab group (P>0.05). CMT decreased in the bevacizumab group from 369 to 284 μm and in the ranibizumab group from 340 to 271 μm (P>0.05). The number of injection was significantly lower (4.8) in the bevacizumab group than in the ranibizumab group (5.8) (P<0.05). No serious ocular adverse events were noted in both groups. CONCLUSION This retrospective study failed to show a difference in visual and anatomic outcomes between bevacizumab and ranibizumab. The number of re-treatment was lower in the bevacizumab group (P=0.03).

Survenue d’une neuropathie optique ischémique antérieure aiguë bilatérale en haute altitude : rôle de l’intolérance à l’hypoxie

The pathophysiology of nonarteritic anterior ischemic optic neuropathy (NA-AION) is still imperfectly understood, but arterial hypertension seems to play a decisive role. Intolerance to hypoxia is defined as desaturation of hemoglobin more than 15% at rest and/or elevation of blood pressure at rest or after exercise over 20mmHg in hypoxia. We report the case of a 66-year-old woman who presented bilateral NA-AION during a trek at high altitude (>2500m). The etiological check up was negative. Due to the circumstances of occurrence, we requested a tolerance to hypoxia test, which was positive. In this case, the combined effects of altitude and effort probably led to prolonged desaturation of oxyhemoglobin associated with an excessive blood pressure increase upon exercise leading to ischemia of the optic nerve head. This case showed the value of a systematic search for hypoxia tolerance in patients with nonarteritic anterior ischemic optic neuropathy occurring during a situation of prolonged hypoxia (long-distance flight, high altitude).

Actualisations de la Fédération France Macula : diagnostic de la DMLA exsudative

PURPOSE To update the recommendations of the France Macula Federation for the diagnosis of wet age-related macular degeneration (AMD). METHODS Analysis of literature and expert opinion. RESULTS The FMF recommends diagnosing wet AMD by combining the results of fundus examination (or color or monochromatic fundus photographs), optical coherence tomography (OCT) showing exudative signs, and morphological visualization of the neovascular membrane, which may be obtained non-invasively (OCT-angiography) or invasively (fluorescein and/or indocyanine green angiography). Under optimal conditions in which all these tools are available, the FMF recommends using non-invasive methods as first-line tools and resorting to dye angiography if diagnostic doubt remains. CONCLUSION As observed in other fields of medical imaging, non-invasive methods are preferred to invasive methods for the diagnosis of wet AMD, while the latter are reserved for more difficult cases.

Accuracy of peripapillary versus macular vessel density in diagnosis of early to advanced primary open angle glaucoma

PURPOSE To evaluate macular and peripapillary vessel density (mVD, pVD) using optical coherence tomography angiography (OCT-A) in healthy subjects, patients with ocular hypertension (OHT) and primary open-angle glaucoma (POAG) patients. METHODS In this prospective observational study, OCT-A images were obtained from 60 eyes of 36 healthy, ocular hypertension (OHT), preperimetric glaucoma (PPG), early glaucoma (EG) and moderate and advanced POAG subjects. Superficial mVD was acquired over a 6×6-mm cube centered on the foveal avascular zone and pVD over a 4.5×4.5-mm cube centered on the optic disc. Peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell complex (GCC) thickness was calculated using spectral-domain OCT. Correlations between vascular, structural and Humphrey VF indices were evaluated (Spearmans rank correlation coefficient). RESULTS Median pVD and mVD in the PPG eyes were lower than in healthy eyes (51.87% and 47.23% versus 55.70% and 53.61%, respectively; P<0.001 and P=0.003), but higher than in mild glaucoma eyes (46.21% and 41.98%, P<0.001 compared to normal eyes) and moderate to advanced glaucoma eyes (37.45% and 39.89%, P<0.0001 compared to normal eyes). The highest correlations were found between structural parameters and pVD (r=0.87 and 0.86 for pRNFL and GCC, P<0.0001), followed by mVD (r=0.69 for both pRNFL and GCC, P<0.0001). Correlations with mean VF sensitivity were similar for pVD and mVD (r=0.61 and 0.56) and for GCC and pRNFL (r=0.60 and 0.52, P<0.0001 for all). CONCLUSIONS VD measured with OCT-A shows reduction in POAG. Detection of this damage differentiates PPG from normal and perimetric POAG eyes with a high correlation with structural parameters. Peripapillary VD accuracy is higher than mVD in detecting the disease. These results suggest that OCT-A could improve POAG diagnosis and understanding of the pathophysiologic mechanisms behind glaucoma.

Real study: Re-treatment evaluated on visual acuity for Lucentis ® in neovascular AMD

PURPOSE To assess the value of a monthly injection of Lucentis® until stable visual acuity (VA) is obtained for three consecutive months without exudation in patients with neovascular age macular degeneration (AMD). METHODS Prospective, single-center, non-controlled trial including naïve AMD patients with neovascularization. An assessment of VA and a spectral domain optical coherence tomography (SD-OCT) were performed at baseline and every month. Monthly injections of Lucentis® were performed over three months. The monthly injections were then continued until three consecutive stable VA results were obtained with no signs of exudation. RESULTS Fifteen out of the 21 patients included were anatomically good responders. A mean gain of +14Le (9) was obtained up to the point at which there was no exudation. There was no additional gain from this point until 3 consecutive stable VA results were obtained. During the PRN phase, an additional mean gain of +3.2Le (7.7) was obtained. CONCLUSION This initial VA-guided regimen with ranibizumab might prevent the slight decrease in VA observed during the first year of PRN studies.

Néovaisseaux choroïdiens du myope fort naïfs traités par injections intravitréennes de bévacizumab : résultats à plus de 12 mois

PURPOSE The purpose of this study was to evaluate the efficacy and safety of bevacizumab in the first-line treatment of myopic choroidal neovascularization. PATIENTS We report a retrospective study of patients with subfoveal or juxtafoveal choroidal neovascularization associated with pathologic myopia treated with intravitreal injection of bevacizumab in Lyon, France, from January 2009 to June 2010. Best-corrected visual acuity, ocular pressure, fundus examination, optical coherence tomography, and fluorescein angiography were performed for each patient at baseline and monthly. Indications for retreatment were persistent or recurrence of exsudative activity. RESULTS The study included eight eyes of eight patients. The mean follow-up time was 19 months. The mean number of intravitreal injections was three at the end of the first year. Six patients maintained or improved their vision. No injection complications or drug-related side effects were noted during the follow-up period. CONCLUSIONS In this study, intravitreal injection of bevacizumab seems to be a safe and effective treatment for myopic choroidal neovascularization.