Karine Palombi

Non‐arteritic anterior ischaemic optic neuropathy is nearly systematically associated with obstructive sleep apnoea

Aim: To evaluate newly diagnosed non-arteritic anterior ischaemic optic neuropathy (NAION) patients for the existence of an associated sleep apnoea syndrome. Methods: Newly identified NAION patient underwent polysomnography. The prevalence of sleep apnoea in NAION patients was compared to the prevalence previously found in the general population. Hypertension, diabetes, hyperlipidaemia, and atheromatous lesions of carotid vessels as classic risk factors associated with NAION were also identified. Results: 27 consecutive newly diagnosed NAION patients (18 men and nine women, mean age 65 (SD 8) years, body mass index 27.2 (3.8) kg/m2) were included in the study. 24 of these 27 NAION patients (89%) exhibited a sleep apnoea syndrome (respiratory disturbance index: 37.2/h (SD 18.3/h). Risk ratio for a NAION patient to have sleep apnoea was 4.9 compared to the general population (p<0.001). Sleep apnoea was 1.5–2-fold more frequent than the rate of the other identified risk factors typically associated with NAION (hypertension, diabetes). Conclusions: Sleep apnoea is the most frequent disorder associated with NAION and should be screened in this population. At least a questionnaire related to obstructive sleep apnoea symptoms and assessment of sleepiness should be systematically proposed to patients with NAION.

Eubacterial PCR for bacterial detection and identification in 100 acute postcataract surgery endophthalmitis.

PURPOSE To evaluate eubacterial PCR compared with conventional cultures for detection and identification of bacterial agents in ocular samples from patients with acute postcataract endophthalmitis. METHODS Broad-range eubacterial PCR amplification was used, followed by direct DNA sequencing in ocular samples (aqueous humor, vitreous samples from tap or vitrectomy) from 100 consecutive patients presenting with acute postcataract endophthalmitis. Bacterial cultures were performed on the same ocular samples by using traditional methods (brain-heart infusion broth). RESULTS At the time of admission, the detection rate was not significantly different between cultures and PCR (38.2% for cultures versus 34.6% for PCR in aqueous humor samples; 54% versus 57% in vitreous from a vitreous tap). In contrast, in the vitreous obtained from vitrectomy, after intravitreous injection of antibiotics, PCR detected bacteria in 70% of the cases, compared with 9% in cultures. By combining PCR and cultures, bacterial identification was obtained in 47% of aqueous humor samples at admission, in 68% of vitreous samples from a vitreous tap at admission, and in 72% of vitreous samples from pars plana vitrectomy. Gram-positive bacteria predominated (94.3%). The concordance between cultures and PCR was 100%. The contamination rate was 2%. CONCLUSIONS Cultures and eubacterial PCR are complementary techniques for bacterial identification in eyes with acute postcataract endophthalmitis. PCR technique was needed for identification of the involved microbial pathogen in 25% of all the cases. Eubacterial PCR is more effective than cultures in detecting bacteria in vitreous samples from patients with previous intravitreous administration of antibiotics.

Twenty-four hour (Nyctohemeral) rhythm of intraocular pressure and ocular perfusion pressure in normal-tension glaucoma.

PURPOSE To characterize the nyctohemeral rhythm of intraocular pressure (IOP) and ocular perfusion pressure (OPP) in patients with newly diagnosed, untreated normal tension glaucoma (NTG). METHODS Twenty-seven patients with suspected NTG were prospectively included and underwent 24-hour monitoring of IOP and blood pressure (BP), polysomnography, and nailfold capillaropathy. The nyctohemeral rhythms of IOP, BP, and OPP were modeled with a nonlinear least-squares, dual-harmonic regression procedure, studying the mean value, the acrophase, the nadir and the amplitude of each rhythm. Nonparametric tests were used to study the relationship between the rhythm of IOP and vascular, sleep, and visual field parameters. RESULTS Five patients were excluded from the analysis after the 24-hour curve of IOP, (IOP > 21 mm Hg during nighttime [n = 1] or daytime [n = 4]). Twenty-two (81%) patients received a diagnosis of NTG (IOP < 22 mm Hg over 24 hours). They exhibited a diurnal acrophase (54.5%), or a nocturnal acrophase (36.4%) of IOP. The remaining patients (9.1%) with NTG had no nyctohemeral rhythm. A significantly higher proportion of patients with capillaropathy and a higher nyctohemeral fluctuation of IOP characterized the IOP group with diurnal acrophase. A rhythm of OPP was found in all patients, (diurnal [58%] or nocturnal [42%]) acrophase) equally distributed between the two groups of IOP. Amplitude of OPP was not significantly associated with the severity or progression of glaucoma. CONCLUSIONS A nyctohemeral rhythm of IOP exists in most of the patients with NTG, either with a nocturnal acrophase or a diurnal acrophase. The rhythm of OPP did not correlate with the IOP rhythm.

Comparative prospective study of rhegmatogenous retinal detachments in phakic or pseudophakic patients with high myopia.

Purpose: To compare the anatomical and functional results of primary rhegmatogenous retinal detachment in highly myopic phakic or pseudophakic eyes. Methods: This prospective 2-center study included 191 consecutive eyes (151 phakic and 40 pseudophakic eyes) from a prospective cohort of 835 patients (IRB #5891, between 2004 and 2008). Baseline and follow-up data were systematically recorded at presentation, 1 month, and 6 months or more after surgery. On final examination, two groups were considered based on the need for one or more surgeries to achieve retinal reapplication. End points were primary reattachment rate at the 6-month visit, final anatomical success rate, postoperative visual acuity, and intraoperative and postoperative complications. Results: Pseudophakic eyes differed from phakic eyes in age (60.8 ± 10.4 vs. 49.9 ± 12.3, P < 0.001), smaller pupil dilation (8.0 ± 1.5 vs. 8.5 ± 1.2 mm, P = 0.02), fewer retinal tears seen preoperatively (1.5 ± 1.6 vs. 2.2 ± 2.2, P = 0.06), more frequent use of pars plana vitrectomy (80% vs. 28.5%, P < 0.001), and higher single reattachment rate (92.5% vs. 80.7%). Visual acuity was greater than or equal to 20/40 in 54% of cases with single retinal detachment surgery and 44% of cases with multiple surgeries. Multiple logistic regression analysis showed that only 3 independent variables were significantly predictive of good final visual acuity (20/40): initial visual acuity (<20/400, odds ratio = 0.19; 95% confidence interval, 0.07–0.51; P = 0.002), axial length (odds ratio = 0.57; 95% confidence interval, 0.44–0.75, P < 0.001), and pars plana vitrectomy (odds ratio = 0.33; 95% confidence interval, 0.15–0.71, P = 0.004). Conclusion: This prospective study showed similar baseline retinal detachment characteristics of high myopic phakic or pseudophakic eyes, suggesting that high myopia was the main pathogenic factor in both groups. Although high myopic eye presents anatomical characteristics that could favor surgical morbidity, these recent prospective data show that high myopic eyes exhibit functional and anatomical prognosis close to that described in emmetropic eyes.

Occurrence and risk factors for retinal detachment after pars plana vitrectomy in acute postcataract bacterial endophthalmitis

Background/aims To report the incidence, risk factors and prognosis of retinal detachment (RD) in patients who had vitrectomy for acute bacterial endophthalmitis after cataract surgery. Methods 123 patients with acute postcataract endophthalmitis, consecutively treated with pars plana vitrectomy (PPV) were included by the French Institutional Endophthalmitis Study group, in a prospective multicentre cohort study. Risk factors of RD were analysed using logistic regression. Results At the 6-month follow-up, the rate of post-PPV RD was 13% (n=16). The risk factors of post-PPV RD were diabetes (OR=4.7 (1.4–15.4), p=0.01) and visualisation of retinal vasculitis on the posterior pole (OR=3.8 (1.1–13.9), p=0.03) at the time of PPV. Postoperative RD occurred in 56% (n=9) of cases in the first month, in 31% (n=5) in the second month and in 6% (n=1) in the third month, with a mean delay of 47±71 days after PPV. The macula was detached in 12 cases (75%) and proliferative vitreoretinopathy grade C was present in seven cases. Final successful reattachment of the retina was obtained in 60% (n=9/15) of cases, with one (7/9) or two surgeries (2/9). Final visual acuity after surgical repair was ≥20/40 in 19% of cases, compared with 43% in patients without RD (p=0.05). Conclusions RD is a major and severe complication of PPV performed in patients with acute postcataract endophthalmitis. Retinal vasculitis is a major risk factor of RD after PPV. Anatomical and functional outcome remain poor.

Longitudinal study of retinal status using optical coherence tomography after acute onset endophthalmitis following cataract surgery

Purpose To analyse the macula imaged with optical coherence tomography (OCT) in patients treated for acute postcataract endophthalmitis. Methods Patients presenting with acute postcataract endophthalmitis were included in this observational and multicentre study from January 2008 to December 2011. We recorded the following OCT data at the 3, 6 and 12-month visits: the central macular thickness, the perifoveal macular thickness, the central foveal point thickness and abnormalities of the outer retina, the macula and vitreoretinal interface. Results 46 patients were included in the OCT analysis. From month 3 to 12, epiretinal membrane (ERM) prevalence increased from 26% to 39%, vitreomacular traction prevalence decreased from 12% to 6%, non-tractional macular oedema (ME) prevalence varied between 7% and 13%. Only macular thinning remained stable at 10%. At month 12, a significant correlation was found between non-tractional ME and capsular rupture (at the time of cataract extraction, p=0.03). Eyes with an ERM exhibited increased central macular thickness (p=0.001) and lower visual acuity (VA) (p=0.02) at M12 in comparison to the group with normal macula. OCT analysis showed a significant association between ERM and the alteration of the ellipsoid band (p=0.02), as well as the external limiting membrane (ELM, p=0.07) at M12. Conclusions ERM and ME were the main macular abnormalities diagnosed after 1 year of follow-up, associated with VA less than or equal to 20/40 in 50% of the cases. Ultrastructural abnormalities of the ELM and the ellipsoid band were frequently observed in those patients.

Anatomical and visual outcome after pars plana vitrectomy in acute postcataract endophthalmitis

Purpose To report visual and anatomical outcome of patients vitrectomized for acute post bacterial endophthalmitis Methods 123 patients with acute postcataract endophthalmitis and consecutively treated by pars plana vitrectomy (PPV) were included in four academic hospitals (French Institutional Endophthalmitis Study (FRIENDS) group). Results At 6 month follow-up, 49 patients (40%) had a visual acuity (VA) greater than or equal to 20/40, and 83 patients (68%) had VA greater than or equal to 20/200. Baseline factors associated with final VA ≥20/40 were a younger age (Odds ratio, OR= 1.05 (1.05-1.09), p=0.006), presence of fundus visibility (OR=7 (1,4-34,6),p=0.007), and absence of cataract surgery complications (OR=15.3 (1.9-32), p=0.001), corneal edema (OR= 2.3 (1.1-4.9), p= 0.02), hypopion (OR= 2.6 (1.1-6.6), p=0.04), or of virulent bacteria (OR=3.1 (1.4-6.7), p=0.005). At the time of PPV, absence of vasculitis at the posterior pole at the time of PPV (OR= 7 (1.4-34.6), p=0.02) and a lower duration of PPV (OR=1.02 (1.01-1.04), p=0.02) were significantly associated with final VA ≥20/40. Risk factors of RD were diabetes (OR = 4.7 (1.4-15.4), p=0.01), and visualization of retinal vasculitis on the posterior pole (OR = 3.8 (1.1-13.9), p= 0.03) at the time of PPV. Conclusion PPV allowed to be beneficial in a majority of the patients. Baseline inflammatory signs and bacterial virulence are the main prognostic visual factors. RD remains the major complication but final anatomical and visual outcome is still poor, despite updated vitreoretinal techniques

091 Prévention du risque de récidive ou de bi-latéralisation de la neuropathie optique ischémique antérieure aiguë chez le patient apnéique traité par ventilation en pression positive continue nocturne

Introduction Le syndrome d’apnees du sommeil est desormais reconnu comme etant un facteur de risque majeur chez les patients atteints de neuropathie optique ischemique anterieure aigue. L’objectif de cette etude est de determiner quel est l’impact du traitement de reference du syndrome d’apnees du sommeil (ventilation par pression positive continue nocturne) sur la survenue de recidives de neuropathie optique ischemique anterieure aigue ou de bi-lateralisation. Materiels et Methodes Quarante-six patients atteints de neuropathie optique ischemique anterieure aigue et syndrome d’apnees du sommeil ont ete expertises lors d’une etude prospective realisee de 2002 a 2007. Un suivi semestriel ophtalmologique a la recherche d’evenements tels que la recidive ou la bi-lateralisation a ete effectue. Une surveillance de l’observance du traitement par ventilation en pression positive continue nocturne a ete realisee grâce a l’evaluation du temps de traitement par nuit. Le nombre d’evenements a ete compare entre le groupe traite et non traite par courbe de survie (Kaplan Meyer). Resultats Treize patients ont ete traites par ventilation en pression positive continue (> 3 heures/nuit). Les patients (sex ratio 3.25) sont âges de 47 a 82 ans. Les patients ont ete traites par pression positive continue 1 a 2 mois apres le diagnostic de neuropathie optique ischemique anterieure aigue. Le groupe non traite etait compose des patients ne relevant pas d’une indication de pression positive continue, des patients refusant le traitement ou non compliants. 2 patients sur 13 ont presente une recidive ou une bi-lateralisation dans le groupe traite contre 7 patients sur 33 dans le groupe non traite. L’etude de survie montre l’absence de difference significative entre les 2 groupes concernant les evenements recidive et bi-lateralisation. Discussion Ces resultats preliminaires tiennent compte d’un suivi inferieur a 4 ans pour certains patients. Les facteurs associes doivent etre egalement analyses (diabete, HTA, aspirine) afin de confirmer ces resultats. Conclusion L’analyse de l’effet protecteur de la pression positive continue sur la survenue de recidive ou de bi-lateralisation de la neuropathie optique ischemique anterieure aigue de notre serie actuelle de 46 patients necessite un suivi a plus long terme.