Michèle Boissonnot

Abnormal retinal thickness in patients with mild cognitive impairment and Alzheimer's disease.

In Alzheimers disease (AD), brain lesions are marked by severe neuronal loss and retinal degeneration was previously mentioned in affected patients. Mild cognitive impairment (MCI) is a clinical syndrome that could be an early phase of AD. In this study, using optical coherence tomography (OCT), the retinal nerve fiber layer (RNFL) thickness was assessed in patients with mild AD, moderate to severe AD, amnestic MCI and control subjects. The results show that RNFL thickness is statistically reduced in patients with MCI, mild AD or moderate to severe AD compared to controls. In addition, no statistical difference was found between the results in MCI patients and mild AD patients. The RNFL seems to be involved early during the course of amnestic MCI and OCT tests could be carried out in patients with cognitive troubles.

Endophthalmitis After Intravitreal Injections: Incidence, Presentation, Management, and Visual Outcome

PURPOSEnTo report the incidence and characteristics of endophthalmitis after intravitreal injections of anti-vascular endothelial growth factor agents or corticosteroids and to describe the clinical and bacteriologic characteristics, management, and outcome of these eyes with acute endophthalmitis in France.nnnDESIGNnRetrospective, nationwide multicenter case series.nnnMETHODSnFrom January 2, 2008 to June 30, 2013, a total of 316,576 intravitreal injections from 25 French ophthalmic centers were included. For each center, the number of intravitreal injections was determined using billing codes and the injection protocol was recorded. A registry and hospital records were reviewed to identify patients treated for endophthalmitis after injection during the same time period. The main outcome measures were the incidence of clinical endophthalmitis and visual acuity of endophthalmitis cases.nnnRESULTSnDuring the study period, 65 cases of presumed endophthalmitis were found, giving an overall incidence of 0.021% (2.1 in 10,000 injections) (95% confidence interval [CI], 0.016%-0.026%). The median number of days from injection to presentation was 4 [1-26] days. The most common symptom was vision loss. Bacterial identification was achieved in 43.4%. The most frequent pathogens were gram-positive bacteria (91.3%), including coagulase-negative Staphylococcus in 78.3%. Neither the interval between injection and presentation for endophthalmitis nor the clinical signs differentiated culture-positive from culture-negative cases. In multivariate analysis, the use of a disposable conjunctival mould assist device and the use of prophylaxis with an antibiotic or antiseptic were significantly associated with an increased incidence of endophthalmitis (P = .001). The majority of patients had worse visual acuity after 3 months of follow-up when compared with acuity before endophthalmitis.nnnCONCLUSIONSnThe incidence of presumed endophthalmitis after intravitreal injections of anti-vascular endothelial growth factors or corticosteroids was low and the prognosis poor. Prevention and management remain challenging. It remains to be determined whether the findings of this study are relevant for other countries using different techniques for intravitreal injections.

Intraventricular Silicone Oil: A Case Report

AbstractIntracranial silicone oil is a rare complication of intraocular endotamponade with silicone oil.We describe a case of intraventricular silicone oil fortuitously observed 38 months after an intraocular tamponade for a complicated retinal detachment in an 82 year-old woman admitted in the Department of Neurology for a stroke. We confirm the migration of silicone oil along the optic nerve. We discuss this rare entity with a review of the few other cases reported in the medical literature.Intraventricular migration of silicone oil after intraocular endotamponade is usually asymptomatic but have to be known of the neurologists and the radiologists because of its differential diagnosis that are intraventricular hemorrhage and tumor.

Intravitreal Ranibizumab in Daily Clinical Practice for Age-Related Macular Degeneration: Treatment of Exudative Age-Related Macular Degeneration in Real Life

Purpose: To describe the anatomical and functional outcomes in patients with exudative age-related macular degeneration (AMD) undergoing ranibizumab therapy in real-life practice. Methods: This is a retrospective analysis of patients with exudative AMD treated with ranibizumab. Visual acuity (VA) and optic coherence tomography characteristics at baseline and at the end of the follow-up, clinical forms of the disease, delay between diagnosis and treatment as well as the number of follow-up visits and of intravitreal injections were collected. Results: One hundred and seventy-nine patients (220 eyes) were followed up during a mean of 24 months. The mean delay between diagnosis and treatment was 20.3 days (SD ±16.8). VA stabilization was observed in 46.4% of eyes, 21.7% of eyes gained ≥15 ETDRS (Early Treatment Diabetic Retinopathy Study) letters and 31.9% lost ≥15 ETDRS letters. The mean central retinal thickness decreased from 380.6 μm at baseline to 295.6 µm at the final examination. A lower baseline VA score was associated with a greater gain of letters (OR 1.04, 95% CI 1.02-1.06; p < 0.001). Conclusion: Shortening the delays in diagnosis appears to be a key point in real-life situations.

Retinal microvascular alterations related to diabetes assessed by optical coherence tomography angiography: A cross-sectional analysis

Abstract Fluorescein angiography has been so far the gold-standard test to assess diabetic macular ischemia (DMI), a cause of irreversible visual impairment in diabetic patients. The aim of this study was to investigate foveal avascular zone (FAZ) and perifoveal microcirculation changes in eyes with nonproliferative diabetic retinopathy (NPDR) using optical coherence tomography angiography (OCTA), a new and noninvasive vascular imaging technique. Cross-sectional study including eyes of diabetic patients with NPDR. All patients underwent medical history, best-corrected visual acuity (BCVA) measurement, slit-lamp and fundus examination, multicolor imaging, SD-OCT, and swept-source OCT. OCTA was performed in order to assess macular superficial and deep capillary plexus, and swept-source OCT was performed to evaluate the central choroidal thickness. Fifty-eight eyes of 35 patients with a mean age of 61.8 years (±12.1) with mean HbA1C level of 7.6% (±1.5) were included in this study. Among them, 19 eyes had mild NPDR, 24 eyes had moderate NPDR, and 15 eyes had severe NPDR. There was a significant progression between NPDR stages for FAZ grade (Pu200a<u200a0.0001), surface (Pu200a=u200a0.0036) and perimeter (Pu200a=u200a0.0001), and for superficial capillary plexus nonperfusion index (NPI) (Pu200a=u200a0.0009). Moreover, a significant correlation was found between NPI and BCVA (Pu200a=u200a0.007). OCT angiography is a useful noninvasive tool to explore early phases of diabetic retinopathy, which are not routinely explore with fluorescein angiography and not precisely enough with color photographs. NPI and foveal avascular zone parameters are correlated with glycated hemoglobin in patients with NPDR. If confirmed by further studies, these results could represent a mean to sensibilize diabetic patients to their disease.

Association Between Diabetic Macular Edema and Cardiovascular Events in Type 2 Diabetes Patients: A Multicenter Observational Study

AbstractDiabetic macular edema (DME) is the main cause of visual loss associated with diabetes but any association between DME and cardiovascular events is unclear.This study aims to describe the possible association between DME and cardiovascular events in a multicenter cross-sectional study of patients with type 2 diabetes.Two thousand eight hundred seven patients with type 2 diabetes were recruited from diabetes and nephrology clinical institutional centers participating in the DIAB 2 NEPHROGENE study focusing on diabetic complications. DME (presence/absence) and diabetic retinopathy (DR) classification were based on ophthalmological report and/or on 30° color retinal photographs. DR was defined as absent, nonproliferative (background, moderate, or severe) or proliferative. Cardiovascular events were stroke, myocardial infarction, and lower limb amputation.Details regarding associations between DME and cardiovascular events were evaluated.The study included 2807 patients with type 2 diabetes, of whom 355 (12.6%) had DME. DME was significantly and independently associated with patient age, known duration of diabetes, HbA1c, systolic blood pressure, and DR stage. Only the prior history of lower limb amputation was strongly associated with DME in univariate and multivariate analyses, whereas no association was found with regard to myocardial infarction or stroke. Moreover, both major (nu200a=u200a32) and minor lower limb (nu200a=u200a96) amputations were similarly associated with DME, with respective odds ratio of 3.7 (95% confidence interval [CI], 1.77–7.74; Pu200a=u200a0.0012) and of 4.29 (95% CI, 2.79–6.61; Pu200a<u200a0.001).DME is strongly and independently associated with lower limb amputation in type 2 diabetic patients.

Prevalence of macular complications associated with high myopia by multimodal imaging

PURPOSEnTo describe the prevalence of macular complications in patients with visual acuity decrease related to high myopia (HM). To establish correlations between these complications and demographic or anatomical characteristics.nnnMATERIALS AND METHODSnCross-sectional observational study including HM patients undergoing best-corrected visual acuity (BCVA), fundus examination, macular SD-OCT, and fluorescein angiography in the case of suspicion of choroidal neovascularization (CNV). The presence of anatomical criteria (staphyloma, subfoveal choroidal thickness [CT]) and macular complications (CNV, lacquer cracks, central chorioretinal atrophy, dome-shaped macula with serous retinal detachment [SRD], retinal foveoschisis, macular hole and epiretinal membrane) was investigated.nnnRESULTSnA total of 87xa0eyes of 47xa0patients were included (39xa0eyes without macular complication and 48xa0eyes with macular complications). In the case of macular complications, decrease in BCVA was related to CNV in 33%, macular hole in 25%, chorioretinal atrophy in 19%, foveoschisis in 11%, lacquer crack in 6%, to a dome-shape macula with serous retinal detachment in 4% and epiretinal membrane in 2%. After adjusting for interocular correlation and degree of myopia, staphyloma (P=0.0023), choroidal thinning (P=0.0036), and extrafoveal chorioretinal atrophy (P=0.042) were significantly associated with macular complications.nnnCONCLUSIONSnHigh myopic patients with staphyloma or choroidal thinning should undergo regular comprehensive retinal screening for retinal complications.

Relationships between macular pigment optical density and lacquer cracks in high myopia

PURPOSEnA low concentration of macular carotenoid pigment (lutein and zeaxanthin) is a significant risk factor for macular degeneration. The goal of this paper is to investigate the relationship between macular pigment optical density (MPOD) and lacquer cracks (LC) in high myopia.nnnMETHODSnThis is a prospective comparative observational study (NCT02205632) including high myopic patients with or without LC. High myopia was defined as a refractive error greater than 6 diopters of myopia or axial length greater than 26mm. All patients underwent best-corrected visual acuity in logMAR, MPOD measurement, multicolor imaging, SD-OCT, autofluorescence and axial length measurement. MPOD was calculated using heterochromatic flicker photometry. Group 1 was defined as eyes without LC and group 2 as eyes with LC.nnnRESULTSnForty-five eyes of 32 patients with a mean age of 51.3 years were included in group 1, and 15 eyes of 13 patients aged 54.1 in group 2 (P=0.56). Mean spherical equivalent was -10.11 diopters in group 1 and -15.11 in group 2 (P=0.0004). Mean visual acuity was +0.08 logMAR (0.8 in decimal notation) in group 1 and +0.11 logMAR (0.8 in decimal notation) in group 2 (P=0.061). Axial length was 27.8mm in group 1 and 29.2 in group 2 (P=0.0052). Central macular thickness was lower in group 1 (295μm) than in group 2 (305μm) (P<0.0001), and macular choroidal thickness did not differ between the two groups (P=0.094). Mean MPOD in group 2 was 0.52 and 0.63 in group 1 (P=0.042). Differences in axial length were not related to MPOD measurements (P=0.74).nnnCONCLUSIONnA lower rate of MPOD was observed in cases of LC in high myopia. Further studies are needed to investigate if dietary carotenoids could have a protective effect in reducing the risk of LC.

571 Rétinopathie à l’interféron alpha : à propos d’un cas

Introduction L’interferon alpha est utilise dans le traitement de l’hepatite chronique C chez des adultes ayant un ARN-VHC serique positif, souvent en association avec la ribavirine. Cet immunomodulateur peut entrainer des retinopathies de type ischemique, associant des nodules cotonneux, des hemorragies, des occlusions de veine ou d’artere retinienne, des neovaisseaux choroidiens. Des cas de neuropathie optique ischemique ont egalement ete rapportes. Materiels et Methodes Description d’un cas clinique. Observation Un patient de 45 ans, VIH +, ancien toxicomane a l’heroine et tabagique, traite depuis 6 mois pour une hepatite C chronique par interferon alpha (135xa0μg/semaine) et ribavirine (800xa0mg/j) nous consultait pour une baisse recente d’acuite visuelle bilaterale (œil droitxa0=xa02/10 et œil gauchexa0=xa07/10). Le fond d’œil et l’angiographie a la fluoresceine montraient une ischemie de la macula majeure a droite et moins importante a gauche. On n’observait par ailleurs aucun nodule cotonneux ni de micro-hemorragie. Ce patient n’etait ni hypertendu, ni anemie, ni diabetique. Un arret de son traitement avait alors ete decide en concertation avec les gastro-enterologues qui le suivaient. A trois mois, l’acuite visuelle restait stable. Le controle angiographique revelait alors une atrophie sequellaire faisant place a l’ischemie maculaire, confirmant le caractere irreversible de cette maculopathie secondaire a l’interferon. Discussion La physiopathologie de la retinopathie a l’interferon alpha reste encore mal connue. Elle semble etre liee a une alteration des cellules endotheliales des vaisseaux et elle est favorisee par l’association a la ribavirine, lors d’une hypertension arterielle, d’une anemie ou d’un diabete. Elle demeure le plus souvent asymptomatique et regressive apres arret du traitement ou diminution des posologies. Conclusion Les patients porteurs d’une hepatite C chronique et a risque traites par interferon alpha devraient beneficier d’un suivi ophtalmologique a la recherche de complications ischemiques imposant l’arret de traitement.