Florence Rasquin

Polypoidal choroidal vasculopathy in Caucasians.

Abstract Purpose: To study the prevalence of polypoidal choroidal vasculopathy (PCV) in Caucasian patients with occult choroidal neovascularization (CNV); to study the clinical spectrum of PCV in Caucasians and the outcome after laser photocoagulation of such lesions. Methods: (1) A consecutive series of 374 eyes of Caucasian patients at least 58 years old, presenting occult CNV, presumed to have age-related macular degeneration (AMD) on fluorescein angiography (FA) were further characterized by indocyanine green angiography (ICGA) to determine the frequency of PCV. (2) The funduscopic, FA and ICGA findings in a cohort of 36 Caucasian patients with PCV were analyzed. (3) The outcome after laser photocoagulation was studied in 14 PCV eyes with a minimum follow-up of 6 months. Results: (1) Fourteen of 374 eyes (4%) presenting occult CNV in patients at least 58 years old were diagnosed as PCV by means of ICG-A. (2) A polypoidal lesion was found in the macula in 22 of 45 PCV eyes, in the peripapillary area in 16 of 45, under the temporal vascular arcade in 6 of 45 and in the midperiphery in 6 of 45. Large or soft drusen were observed in 15 of 45 eyes with PCV. (3) Regression of fundus signs without persisting polyps 6 months after laser photocoagulation was obtained in 5 of 5 treated peripapillary lesions but in only 5 of 9 treated macular or arcade lesions. Conclusion: Polypoidal choroidal vasculopathy is not rare in Caucasian patients presenting with occult choroidal neovascularization. The fundus abnormalities seen in such eyes overlap with the typical manifestations of AMD. Whereas the prognosis after photocoagulation of peripapillary polypoidal lesions appears to be relatively good, it is more guarded for macular or arcade lesions.

Diffuse Unilateral Subacute Neuroretinitis in Africa

Purpose: Diffuse unilateral subacute neuroretinitis (DUSN) is well known in endemic areas of the southeastern United States, South America, and the northern Midwestern United States. Two different categories of nematodes, according to their length, are related to endemic areas. We report the first case of DUSN caused by a small nematode in Africa. Methods: We describe the case of a 12-year-old Senegalese girl who presented a long-standing diffuse unilateral subacute neuroretinitis and in whom the worm could be localized. Results: The length of the unidentified worm measured using the software of the fundus camera was approximately 600 μ m. This measurement corresponds to the smaller nematode usually found in patients from the southeastern United States and South America. Conclusion: Diffuse unilateral subacute neuroretinitis can also be observed in patients living in Africa.

Spectral domain optical coherence tomography findings in early deferoxamine maculopathy: Report of two cases

PURPOSE To describe spectral domain optical coherence tomography features in two cases of early deferoxamine induced retinal toxicity. METHODS Two patients complained of sudden bilateral visual loss and dyschromatopsia. Both suffered from acute myelocytic leukemia with severe aplastic anemia and were treated with intravenous deferoxamine for 1 month. First ophthalmologic exploration and follow-up included fundoscopic examination, fluorescence angiography, fundus autofluorescence, and spectral domain optical coherence tomography. RESULTS Initially, both patients presented with a decreased visual acuity, inferior to 20/100. Fundus examination revealed a loss of transparency of the outer retina in the two cases. Autofluorescence pictures displayed hypoautofluorescence in the macular area, whereas fluorescein angiography unveiled an annular hyperfluorescence staining in the macular zone. Spectral domain optical coherence tomography showed a serous detachment of the neuroepithelium associated with photoreceptor outer segment elongation. Deferoxamine toxicity was immediately suspected and therapy promptly interrupted. One week later, both patients recovered visual acuity of 20/20 but retinal pigment epithelium (RPE) mottling was noticed in the macular areas. Spectral domain optical coherence tomography monitoring showed a progressive resolution of serous retinal detachment. Elongation of the photoreceptor outer segment disappeared but the RPE remained thickened, interrupted, and fragmented at different macular loci. CONCLUSION Serous detachment of the neuroepithelium associated with photoreceptor outer segment elongation in the early stage of deferoxamine maculopathy is described for the first time. Early drug discontinuation allowed a fast resolution of the serous detachment but the typical RPE pigment mottling observed at the resolution phase was noticed 1 week later.

Long-term results of low-fluence photodynamic therapy for chronic central serous chorioretinopathy

PURPOSE To evaluate long-term results of low-fluence photodynamic therapy (PDT) with verteporfin in the treatment of chronic central serous chorioretinopathy (CCSC). METHODS Retrospective medical record review of 38 eyes (34 patients) who received low-fluence PDT for the treatment of CCSC. Visual acuity (VA), fundus biomicroscopy, fluorescein angiography (FA), indocyanine green angiography (ICG) and optical coherence tomography (OCT) were analyzed. RESULTS Thirty-eight eyes (34 patients) with CCSC received low-fluence PDT. Mean follow-up after PDT was 43.97 months. Mean logMar best corrected VA (BCVA) improved significantly from 0.33 to 0.11 at the last follow-up which corresponds to a gain of 2.2 lines. At 3 months, complete resolution of central subretinal fluid was achieved on OCT after 1 PDT in 37 eyes and after 2 PDTs in 1 eye (retreated at 3 months after first PDT). One patient developed choroidal neovascularization (CNV) 4 years after his low-fluence PDT and received anti-vascular endothelial growth factor (VEGF) injections. CONCLUSION Low-fluence PDT with verteporfin for CCSC seems efficacious and safe in the long-term.

Necrotising retinopathy-like lesions as a manifestation of ocular sarcoidosis

BackgroundA 56-year-old Caucasian man presented with a 2-weeks history of decreased vision in the right eye. Vitritis, papillitis, cystoid macular oedema and inferior diffuse retinal infiltration were noticed. Extensive blood work-up, anterior chamber paracentesis with polymerase chain reaction (PCR) and Goldmann-Witmer coefficient, tuberculin skin test (PPD-test), fluorodeoxyglucose Positron Emission Tomography CT scan (FDG-PET/CT), lymph node biopsy and pars plana vitrectomy were performed.ResultsAqueous and vitreous samples were negative for an infectious and a lymphoproliferative etiology. Enlarged hilar and mediastinal lymph nodes were detected by FDG-PET/CT and subsequently biopsied, allowing to confirm the diagnosis of sarcoidosis. After a few months of oral corticosteroid therapy, the inflammation resolved completely and was replaced by atrophic retinal scars.ConclusionNecrotising retinopathy-like lesions mimicking an infectious process or a lymphoproliferative disorder can be an atypical manifestation of ocular sarcoidosis.