Solange Milazzo

Effectiveness and safety of dexamethasone implants for postsurgical macular oedema including Irvine–Gass syndrome: the EPISODIC-2 study

Aim To assess the effectiveness and safety of intravitreal dexamethasone implants for treating post-surgical macular oedema, including Irvine-Gass syndrome refractory to first-line treatments. Methods Descriptive, observational, retrospective, consecutive, uncontrolled, multicentre, national case series. 50 patients were included in the study between March 2011 and June 2013 with a minimum 6 months follow-up. At baseline, each patient received a dexamethasone implant 0.7 mg (Ozurdex). Best-corrected visual acuity (BCVA), central subfield macular thickness (CSMT), and intraocular pressure (IOP) were measured at baseline and then monthly. The main outcome measure was the mean change in BCVA (in ETDRS letters (Early Treatment Diabetic Retinopathy Study): L) Results Baseline mean±SD BCVA was 55.7±15.4 L. At month 2, BCVA was 71.8±10.5 L and 61.2% of patients had an increase of more than 15 letters. Baseline mean CSMT was 544±117.2 μm and this decreased to 302 μm at month 2. Anatomic and functional recurrences were both first detected from month 3 and continued throughout follow-up, with values consistently above baseline. The peak in IOP was reached in month 1 with mean IOP of 15.3±4.6 mm Hg. Of the 39/50 patients followed up for 12 months, 49% received a second injection. The anatomic and functional response and safety patterns were similar to that obtained with the first intravitreal injection, demonstrating Ozurdex’s reproducibility. However, more than half of the patients followed-up for at least 1 year presented neither functional nor anatomical recurrence. Conclusions Ozurdex would appear to be an interesting alternative therapy for treating post-surgical macular oedema, including Irvine-Gass syndrome refractory to first-line treatments.

Ocular blood flow and cerebrospinal fluid pressure in glaucoma

Disease mechanism underlying glaucoma remains unclear. Extensive research on this pathology has highlighted changes in vascular parameters and in circulation of the cerebrospinal fluid (CSF). Here, we review the most recent research on alterations in ocular blood flow and/or CSF flow in glaucoma. Ultrasound Doppler imaging studies have shown an increased resistive index in ophthalmic artery’s in glaucoma. Furthermore, changes in optic nerve CSF circulation, which can be assessed with magnetic resonance imaging, may lead to a greater translaminar pressure difference, mechanical stress, and poor clearance of toxic substances. This constitutes a new approach for understanding blood–CSF interactions involved in glaucoma.

Unusual acute endophthalmitis due to an as yet unclassified Acinetobacter gyllenbergii-like isolate.

We report a case of postoperative endophthalmitis due to an as yet unclassified Acinetobacter gyllenbergii-like isolate. The functional outcome was rapidly negative despite antibacterial therapy. This novel species, which cannot be identified by classical biochemical methods, may represent an underestimated opportunistic pathogen responsible for acute pyogenic infections.

Diffuse multiple sclerosis and chronic central serous chorioretinopathy: pitfall not to ignore

High-dose intravenous corticosteroids are effective in treating acute optic neuritis.1 However, certain ophthalmological conditions should be considered before treatment as they can be worsened by corticosteroids: this emphasises the need for collaboration between neurologists and neuro-ophthalmologists.2 ,3 A 47-year-old man presented in 1999 with right-sided optic neuritis. This was treated with intravenous corticosteroids and he made a good recovery, with post-treatment visual acuity of 6/6. Between 1999 and 2004, he had several episodes of sensory symptoms, not requiring treatment. Imaging corroborated the clinical diagnosis of multiple sclerosis4 and he was treated with weekly interferon s1a (Avonex) 30 µg. In 2005, he presented with a left optic neuritis, treated by high dose corticosteroids and again with good ophthalmological recovery. Unfortunately, in 2006, he began to develop a progressive paraplegia. He then presented with bilateral impairment of vision, with decreased visual acuity to 6/19 (right) and 6/9.5 (left). He did not undergo dilated fundus examination. He also reported worsening of the motor symptoms and sphincter disturbance. Intravenous high-dose corticosteroids treatment was started and, despite the treatment, he reported a painless decrease of visual acuity in the right eye, with a scotoma resembling a …

Dietary, environmental, and genetic risk factors of Extensive Macular Atrophy with Pseudodrusen, a severe bilateral macular atrophy of middle-aged patients

EMAP (Extensive Macular Atrophy with Pseudodrusen) is a maculopathy we recently described that shares pseudodrusen and geographic atrophy with Age-related Macular Disease (AMD). EMAP differs from AMD by an earlier age of onset (50-55 years) and a characteristic natural history comprising a night blindness followed by a severe visual loss. In a prospective case-control study, ten referral centers included 115 EMAP (70 women, 45 men) patients and 345 matched controls to appraise dietary, environmental, and genetic risk factors. The incidence of EMAP (mean 2.95/1.106) was lower in Provence-Côte d’Azur with a Mediterranean diet (1.9/1.106), and higher in regions with intensive farming or industrialized activities (5 to 20/1.106). EMAP patients reported toxic exposure during professional activities (OR 2.29). The frequencies of common AMD complement factor risk alleles were comparable in EMAP. By contrast, only one EMAP patient had a rare AMD variant. This study suggests that EMAP could be a neurodegenerative disorder caused by lifelong toxic exposure and that it is associated with a chronic inflammation and abnormal complement pathway regulation. This leads to diffuse subretinal deposits with rod dysfunction and cone apoptosis around the age of 50 with characteristic extensive macular atrophy and paving stones in the far peripheral retina.

Décollement séreux rétinien dans l’épithéliopathie en plaques : à propos d’un cas

Ophthalmoscopic examination revealed multiple small subretinal yellowish-white, round, discrete, flat lesions <1/4 disc diameter in size scattered all over the posterior pole. More confluent lesions were present near the macula. Lesions were scattered temporal to the macula and nasal to the disc up to the midperiphery. The peripheral lesions were more oval and more ill defined. Associated retinal edema was present and the disc was normal.

Quantification of blood flow in the superior ophthalmic vein using phase contrast magnetic resonance imaging

&NA; Phase contrast magnetic resonance imaging (PC MRI), a validated, non‐invasive technique for measuring intracranial blood and cerebrospinal flows, has been recently applied to studies of blood flow of the ophthalmic artery (OA). This study evaluated PC‐MRIs ability to quantify blood flow in the superior ophthalmic vein (SOV). We analyzed with 3 T PC MRI the blood flow in the SOV in 11 healthy subjects and, for comparison purpose, in the OA. Segmentation software was used to analyze the PC images and quantify the variation in blood flow over the cardiac cycle in each of the vessels. The anatomy of the orbital veins was also assessed. We were able to measure the blood flow in 19 SOV; the mean ± standard deviation (SD) SOV flow was 9.13 ± 7.10 mL/min with a mean ± SD variation of flow during cardiac cycle of 8.45 ± 4.90 mL/min. The mean ± SD flow in the OA was 12.83 ± 8.36 mL/min. The SOV was constantly present, with a mean cross‐sectional area of 2.43 mm2. A medium and an inferior ophthalmic veins were found in 5 and 3 orbits, respectively. In conclusion, PC MRI is able to measure SOV as well as OA flows. To the best of our knowledge, the present study is the first to provide quantitative SOV blood flow values using PC MRI. Investigations of hydrocephalus, intracranial hypertension and even glaucoma might be facilitated by the application of this quantitative imaging modality. HighlightsPhase contrast MRI is able to assess blood flow in the superior ophthalmic vein.Mean flow and waveform characteristics were quantitatively measured.The mean ± SD flow in the superior ophthalmic vein was 9.13 ± 7.10 mL/min.The variability of the anatomy of the ophthalmic veins was analyzed.

Clinical and surgical risk factors for consecutive exotropia

Introduction: Consecutive exotropia is one of the complications of esotropia surgery. Its prevalence is estimated at 4%–27%. The aim of this study was to identify the risk factors for consecutive exotropia in the aftermath of surgical treatment of esotropia. Methods: Seventy-four patients examined in our strabismus consultation for a consecutive exotropia from January 2010 to June 2016 were retrospectively included. The age of onset of esotropia, the presence of amblyopia, the age of esotropia surgery and chosen procedure, the refractive errors, the anomalies of ocular motility, the age of onset of the consecutive exotropia and its angle of deviation were reported. Statistical analyses were performed with Student’s test and Fisher’s exact test. Results: Esotropia occurred in 65% of cases before the age of 1 year, was associated with amblyopia in 51%, hyperopia in 55% or anisometropia in 31%. Surgery was performed before the age of 6 years for 55% of the patients and involved for 52% the both medial recti. The angle of deviation of consecutive exotropia was ≤20 prism dioptres (PD) in 39%, 21-40 PD in 39% and ≥ 40 PD in 22%, related to amblyopia (p = 0.028), and to high hypermetropia (p = 0.05). Discussion: Amblyopia and hyperopia were the most important risk factors of consecutive exotropia in our series. Early onset esotropia, stereopsis abnormalities, anisometropia, oblique dysfunction, convergence insufficiency appeared but did not reach statistical significance. Conclusion: Amblyopia is a major risk factor that should be taken into consideration during surgery of an esotropia.

Clostridium perfringens panophthalmitis and orbital cellulitis: a case report

BackgroundClostridium perfringens is an uncommon pathogen in endophthalmitis, causing rapid destruction of ocular tissues. Clostridium perfringens infection typically occurs after penetrating injury with soil-contaminated foreign bodies.Case reportHere, we describe the case of a 17-year-old male who sustained a penetrating injury with a metallic intraocular foreign body and who rapidly developed severe C. perfringens panophthalmitis with orbital cellulitis. He was managed by systemic and intravitreal antibiotics, resulting in preservation of the globe, but a poor visual outcome.ConclusionClostridial endophthalmitis secondary to penetrating injuries is a fulminant infection, almost always resulting in loss of the globe in the case of advanced infection. When feasible, early vitrectomy and intravitreal antibiotics should be considered in patients with penetrating eye injuries with contaminated foreign bodies.

Description clinique centrée sur l’imagerie IRM, dans une neuropathie optique évolutive d’un glaucome à pression normale

Introduction Le glaucome est une neuropathie optique chronique, progressive, dont le traitement repose sur l’abaissement de la pression intra-oculaire. Nous rapportons les resultats d’imagerie IRM morphologique et en sequences de flux chez un patient souffrant d’un glaucome rapidement evolutif malgre un tonus bien controle. Description clinique Un patient etait suivi pour un glaucome primitif a angle ouvert avec un controle optimal de la pression intraoculaire. Malgre l’appareillage d’un syndrome d’apnee du sommeil et une modification du traitement anti-hypertenseur, le champ visuel s’aggravait de facon bilaterale. Une IRM a permis d’eliminer une cause compressive, cependant une dilatation des gaines du nerf optique etait remarquee de facon bilaterale, ainsi qu’un aspect de selle turcique vide. L’analyse des sequences de flux montrait une hemo-hydrodynamique intracrânienne normale mais des debits mesures dans l’artere ophtalmique globalement augmentes, avec de fortes variations au cours du cycle cardiaque. Discussion La neuropathie optique glaucomateuse est une maladie evolutive complexe, dont la physiopathologie est encore mal connue. L’existence supposee d’une diminution des apports sanguins de la tete du nerf optique justifie, dans un glaucome evolutif, la recherche de syndrome d’apnee du sommeil et d’hypotensions arterielles nocturnes. La circulation du LCS qui entoure le nerf optique pourrait etre alteree, modifiant le gradient de pression au niveau de la lame criblee. Il semblerait egalement que la pression intracrânienne soit abaissee, mais la gaine du nerf optique serait plus large dans les glaucomes a pression normale. Une compartimentalisation pathologique de la gaine du nerf optique a ete supposee a la fois dans l’hypertension intracrânienne idiopathique et dans les glaucomes a pression normale. Conclusion Le glaucome a pression normale et l’hypertension intracrânienne idiopathique presentent des caracteristiques communes, sans pour autant s’associer cliniquement. Les hypotheses physiopathologiques semblent incriminer pour ces deux pathologies un trouble de la dynamique du liquide cerebrospinal.