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Souissi S, Allou V, Trucchi L, Le Mer Y, Tadayoni R, Couturier A. Macular oedema secondary to rhegmatogenous retinal detachment repair: risk factors for resistance to first-line therapy and long-term response to dexamethasone intravitreal implant. Eye (Lond) 2024; 38:1155-1161. [PMID: 38040966 PMCID: PMC11009244 DOI: 10.1038/s41433-023-02852-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 11/02/2023] [Accepted: 11/14/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVES To assess the risk factors for resistance to first-line therapy and long-term response to dexamethasone intravitreal implant (Ozurdex®) of patients with macular oedema (MO) secondary to rhegmatogenous retinal detachment repair (RRDR). METHODS This was a retrospective, consecutive cohort study conducted in patients who underwent RRDR between January 2014 and December 2020 in the Rothschild Foundation Hospital and experienced postoperative MO (POMO) with a follow-up of at least 18 months. RESULTS Of the 1152 patients screened, 36 eyes (3.1%) experienced POMO. The mean follow-up duration was 45.2 months (18.0-80.5 months). Twenty-five eyes (69.4%) were resistant to first-line therapy and received at least one Ozurdex® injection (mean number: 2.7 [1-12]). The multivariate analysis showed an increased risk of resistance in patients who underwent perfluorocarbon liquid (PFCL)-assisted drainage (adjusted odds ratio: 8.65; 95% confidence interval: 1.97-15.33; p = 0.01). Significant differences in best-corrected visual acuity and central macular thickness were found between before Ozurdex® injection and the last follow-up visit: from 0.57 ± 0.47 LogMAR to 0.34 ± 0.32 LogMAR (p = 0.02) and from 483.0 ± 124.0 µm to 354.6 ± 96.5 µm (p = 0.001), respectively. The absence of serous retinal detachment and the presence of hyperreflective foci at baseline were associated with a higher resistance and a poorer response to Ozurdex®. Two patients (8%) experienced hypertony, that was well controlled with hypotonic drops. CONCLUSION MO secondary to RRDR is challenging. Ozurdex® could be reasonably proposed as first-line treatment, at least when MO occurs following PFCL-assisted drainage, given the favourable long-term benefit/risk ratio.
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Affiliation(s)
- Soufiane Souissi
- Department of Vitreoretinal Surgery, Rothschild Foundation Hospital, 25-29 rue Manin, 75019, Paris, France.
| | - Violaine Allou
- Department of Vitreoretinal Surgery, Rothschild Foundation Hospital, 25-29 rue Manin, 75019, Paris, France
| | - Laura Trucchi
- Department of Vitreoretinal Surgery, Rothschild Foundation Hospital, 25-29 rue Manin, 75019, Paris, France
| | - Yannick Le Mer
- Department of Vitreoretinal Surgery, Rothschild Foundation Hospital, 25-29 rue Manin, 75019, Paris, France
| | - Ramin Tadayoni
- Department of Vitreoretinal Surgery, Rothschild Foundation Hospital, 25-29 rue Manin, 75019, Paris, France
- Department of Ophthalmology, Lariboisière Hospital, 2 rue Ambroise Paré, 75010, Paris, France
| | - Aude Couturier
- Department of Ophthalmology, Lariboisière Hospital, 2 rue Ambroise Paré, 75010, Paris, France
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de Saint Sauveur G, Sayadi S, Lejoyeux R, Salviat F, Tadayoni R, Bruneau S, Bonnin S, Le Mer Y. Incidence of macular displacement after rhegmatogenous retinal detachment surgery using ultra-widefield fundus autofluorescence. Int Ophthalmol 2024; 44:66. [PMID: 38347237 DOI: 10.1007/s10792-024-03018-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/09/2024] [Indexed: 02/15/2024]
Abstract
PURPOSE The incidence of retinal displacement after rhegmatogenous retinal detachment (RRD) surgery is variable and its clinical consequences are unclear. The aim of this study was to assess the incidence and clinical features of retinal displacement after RRD surgery by using ultra-widefield (UWF) imaging. METHODS Retrospective observational study including all consecutive patients who underwent RRD surgery at the Rothschild Foundation Hospital. Postoperative data included the visual acuity and symptoms of visual impairment. Macular retinal displacement occurrence and its features were assessed and measured by using the autofluorescence images. RESULTS A total of 123 eyes were included. UWF fundus autofluorescence revealed the presence of macular retinal displacement in 14 (11%) eyes. All displacements were inferior, with a mean angle of 3.8°. Patients with and without macular displacement did not differ in postoperative visual acuity. The retinal detachment extent and preoperative macular involvement were not significantly associated with the occurrence of retinal displacement. CONCLUSION In this representative cohort of eyes that underwent RRD surgery with systematic screening for postoperative retinal displacement by UWF fundus autofluorescence, 11% of eyes experienced an inferior retinal shift. As in other cohorts, the presence of metamorphopsia was not associated with the occurrence of retinal shift.
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Affiliation(s)
- Guy de Saint Sauveur
- Ophthalmology Department, Rothschild Foundation Hospital, 29 rue Manin, 75940, Paris-Cedex 19, France
| | - Sana Sayadi
- Ophthalmology Department, Rothschild Foundation Hospital, 29 rue Manin, 75940, Paris-Cedex 19, France
| | - Raphaël Lejoyeux
- Ophthalmology Department, Rothschild Foundation Hospital, 29 rue Manin, 75940, Paris-Cedex 19, France
| | - Flore Salviat
- Ophthalmology Department, Rothschild Foundation Hospital, 29 rue Manin, 75940, Paris-Cedex 19, France
| | - Ramin Tadayoni
- Ophthalmology Department, Rothschild Foundation Hospital, 29 rue Manin, 75940, Paris-Cedex 19, France
| | - Sébastien Bruneau
- Ophthalmology Department, Rothschild Foundation Hospital, 29 rue Manin, 75940, Paris-Cedex 19, France
| | - Sophie Bonnin
- Ophthalmology Department, Rothschild Foundation Hospital, 29 rue Manin, 75940, Paris-Cedex 19, France.
| | - Yannick Le Mer
- Ophthalmology Department, Rothschild Foundation Hospital, 29 rue Manin, 75940, Paris-Cedex 19, France
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Baillif S, Staccini P, Weber M, Delyfer MN, Le Mer Y, Gualino V, Collot L, Merite PY, Creuzot-Garcher C, Kodjikian L, Massin P. Management of Patients with Diabetic Macular Edema Switched from Dexamethasone Intravitreal Implant to Fluocinolone Acetonide Intravitreal Implant. Pharmaceutics 2022; 14:pharmaceutics14112391. [PMID: 36365209 PMCID: PMC9693281 DOI: 10.3390/pharmaceutics14112391] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/13/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022] Open
Abstract
To assess anatomical and functional outcomes after switching from dexamethasone implant (DEXi) to fluocinolone acetonide implant (FAci) in 113 diabetic macular edema eyes, a multicentric retrospective observational study was conducted. Seventy-five eyes (73.5%) were switched 1−8 weeks after their last DEXi. The mean best-corrected visual acuity improved to 59.8 letters at month 4 and remained stable during the follow-up. The mean central macular thickness (CMT) significantly decreased during the follow-up, with a minimum of 320.9 μm at month 3. The baseline CMT was higher in eyes that received the last DEXi >8 weeks versus <8 weeks before the first FAci (p < 0.021). After FAci injection, additional treatments were needed in 37 (32.7%) eyes. A longer diabetes duration (p = 0.009), a longer time between the last DEXi and the first FAci (p = 0.035), and a high baseline CMT (p = 0.003) were risk factors for additional treatments. The mean intraocular pressure was <19 mmHg at all timepoints, with no difference between eyes receiving the last DEXi ≤8 weeks or >8 weeks before the switch. Switching from DEXi to FAci in DME is effective and safe. A short time between the last DEXi and the first FAci reduced CMT fluctuations and the need for early additional treatments.
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Affiliation(s)
- Stéphanie Baillif
- Department of Ophthalmology, Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 30 Voie Romaine, 06000 Nice, France
- INSERM DR2 U1065, C3M, 151 Avenue Saint-Antoine de Ginestière, 06024 Nice, France
- Correspondence:
| | - Pascal Staccini
- Research Unit RETINES (Risks, Epidemiology, Territories, Information and Education for Health), Université Côte d’Azur, Faculté de Médecine, 28 Avenue de Valombrose, CEDEX 2, 06107 Nice, France
| | - Michel Weber
- Department of Ophthalmology, Centre Hospitalier Universitaire de Nantes, 44000 Nantes, France
| | - Marie-Noëlle Delyfer
- Department of Ophthalmology, Bordeaux University Hospital, 33000 Bordeaux, France
- INSERM, BPH, UMR1219, Bordeaux University, 33000 Bordeaux, France
| | - Yannick Le Mer
- Department of Ophthalmology, A. de Rothschild Ophthalmologic Foundation, 75019 Paris, France
| | - Vincent Gualino
- Clinique Honoré Cave, Department of Ophthalmology, 82000 Montauban, France
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, Université de Paris, 75014 Paris, France
| | - Laurence Collot
- Centre Médico-Chirurgical de Chaumont, 17 Avenue des États-Unis, 52000 Chaumont, France
| | - Pierre-Yves Merite
- Centre D’ophtalmologie, 44 Avenue de Lattre de Tassigny, 13090 Aix-en-Provence, France
| | | | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69002 Lyon, France
- UMR-CNRS 5510 Matéis, University of Lyon, 69622 Villeurbanne, France
| | - Pascale Massin
- Ophthalmic Centre of Breteuil, 14 avenue de Breteuil, 75007 Paris, France
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Muqit MMK, Mer YL, Holz FG, Sahel JA. Long-term observations of macular thickness after subretinal implantation of a photovoltaic prosthesis in patients with atrophic age-related macular degeneration. J Neural Eng 2022; 19:10.1088/1741-2552/ac9645. [PMID: 36174540 PMCID: PMC9684097 DOI: 10.1088/1741-2552/ac9645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/29/2022] [Indexed: 11/12/2022]
Abstract
Objective. Subretinal prostheses electrically stimulate the residual inner retinal neurons to partially restore vision. We investigated the changes in neurosensory macular structures and it is thickness associated with subretinal implantation in geographic atrophy (GA) secondary to age-related macular degeneration (AMD).Approach. Using optical coherence tomography, changes in distance between electrodes and retinal inner nuclear layer (INL) as well as alterations in thickness of retinal layers were measured over time above and near the subretinal chip implanted within the atrophic area. Retinal thickness (RT) was quantified across the implant surface and edges as well as outside the implant zone to compare with the natural macular changes following subretinal surgery, and the natural course of dry AMD.Main results. GA was defined based on complete retinal pigment epithelium and outer retinal atrophy (cRORA). Based on the analysis of three patients with subretinal implantation, we found that the distance between the implant and the target cells was stable over the long-term follow-up. Total RT above the implant decreased on average, by 39 ± 12µm during 3 months post-implantation, but no significant changes were observed after that, up to 36 months of the follow-up. RT also changed near the temporal entry point areas outside the implantation zone following the surgical trauma of retinal detachment. There was no change in the macula cRORA nasal to the implanted zone, where there was no surgical trauma or manipulation.Significance. The surgical delivery of the photovoltaic subretinal implant causes minor RT changes that settle after 3 months, and then remain stable over long-term with no adverse structural or functional effects. Distance between the implant and the INL remains stable up to 36 months of the follow-up.
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Affiliation(s)
- Mahiul M K Muqit
- Vitreoretinal Service, Moorfields Eye Hospital, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
| | - Yannick Le Mer
- Department of Ophthalmology, Fondation Ophtalmologique A. de Rothschild, Paris, France
| | - Frank G Holz
- University of Bonn, Department of Ophthalmology, Bonn, Germany
| | - José A Sahel
- Department of Ophthalmology, Fondation Ophtalmologique A. de Rothschild, Paris, France
- Clinical Investigation Center INSERM-DGOS 1423, Quinze-Vingts National Eye Hospital, Paris, France
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
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Baudin F, Deschasse C, Gabrielle P, Berrod JP, Le Mer Y, Arndt C, Tadayoni R, Delyfer MN, Weber M, Gaucher D, Saleh M, Chiquet C, Creuzot‐Garcher C. Functional and anatomical outcomes after successful repair of macula-off retinal detachment: a 12-month follow-up of the DOREFA study. Acta Ophthalmol 2021; 99:e1190-e1197. [PMID: 33576133 DOI: 10.1111/aos.14777] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/11/2020] [Accepted: 01/13/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To report visual and anatomical outcomes and determine predictors of good visual acuity (VA) recovery after macula-off rhegmatogenous retinal detachment (RD). METHODS Prospective multicentre study including 115 eyes from 115 patients successfully operated on for RD, with assessment of VA and spectral-domain optical coherence tomography (SD-OCT) macular images at 1, 3, 6 and 12 months after surgery. RESULTS Over the follow-up period, VA significantly improved from median [IQR] 62 [46; 72] ETDRS letters at 1 month to 75 [67; 80] ETDRS letters at 12 months (p < 0.001) with a concomitant decreased number of eyes with any SD-OCT lesions (p < 0.001). The presence of subretinal fluid (SRF) significantly decreased (p < 0.001), as did the number of photoreceptor (PR) layer lesions (p = 0.04). At 12 months, lesions in the PR layer and poor VA recovery were significantly associated with a longer time to surgery (p = 0.007 and p < 0.001, respectively). The rate of patients without PR lesions increased from 40.9% at 1 month to 60.0% at 6 months and 73.9% at 12 months (p < 0.001). The incidence of epiretinal membrane (ERM) significantly increased (p < 0.001), while cystoid macular oedema (CME) remained stable over time. Visual acuity (VA) at 3 months postoperatively was a good reflection of final VA recovery (p < 0.001). CONCLUSION Visual acuity (VA) improved in parallel with the decreasing number of eyes with SD-OCT lesions after macula-off rhegmatogenous RD. A long time to surgery was the only preoperative factor associated with poor VA recovery after retinal detachment surgery.
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Affiliation(s)
- Florian Baudin
- Department of Ophthalmology University Hospital Dijon France
- EA 7460 Pathophysiology and Epidemiology of Cerebro‐Cardiovascular Diseases (PEC2) University Hospital Dijon France
| | | | | | - Jean P. Berrod
- Department of Ophthalmology University Hospital Nancy France
| | - Yannick Le Mer
- Department of Ophthalmology Fondation A. de Rothschild Paris France
| | - Carl Arndt
- Department of Ophthalmology University Hospital Reims France
| | - Ramin Tadayoni
- Department of Ophthalmology Lariboisière Hospital Paris France
| | | | - Michel Weber
- Department of Ophthalmology University Hospital Nantes France
| | - David Gaucher
- Department of Ophthalmology University Hospital Strasbourg France
- Bacteriology institute, UR‐7290 Strasbourg University Strasbourg France
| | - Maher Saleh
- Department of Ophthalmology University Hospital Besançon France
| | | | - Catherine Creuzot‐Garcher
- Department of Ophthalmology University Hospital Dijon France
- Eye and Nutrition Research group GSGA UMR 1324 INRA 6265 CNRS Dijon France
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Souissi S, Le Mer Y, Metge F, Portmann A, Baudouin C, Labbé A, Hamard P. An update on continuous-wave cyclophotocoagulation (CW-CPC) and micropulse transscleral laser treatment (MP-TLT) for adult and paediatric refractory glaucoma. Acta Ophthalmol 2021; 99:e621-e653. [PMID: 33222409 DOI: 10.1111/aos.14661] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 09/06/2020] [Accepted: 10/11/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Continuous-wave cyclophotocoagulation (CW-CPC) is often preferred to medical and surgical treatments for managing refractory glaucoma. This review summarizes diode CW-CPC indications, history, histopathology, methods, efficacy and safety. It also provides an overview of the latest data available on micropulse transscleral laser treatment (MP-TLT) that uses repetitive micropulses of diode laser energy in an off-and-on cyclical fashion. METHODS A literature review was conducted on transscleral CW-CPC (CW-TSCPC), endoscopic CPC (ECP) and MP-TLT. Relevant series of adult and paediatric patients were included for assessing the procedures. RESULTS Regarding CW-TCPC, highly variable success rates are reported in the literature, depending on the definition of success, type of underlying glaucoma, energy settings, follow-up duration and retreatment rates. CW-CPC often needs to be repeated, especially in paediatric patients. CW-CPC exposes to risks of inflammation and chronic ocular hypotony or phthisis with irreversible visual loss. CW-TSCPC has mainly been used in very severe forms of glaucoma, in painful eyes with limited visual potential or after filtering surgery failure. Published data on ECP are more limited but overall good success rates have been reported. Through the direct visualization of the targeted ciliary body in anatomically abnormal eyes, ECP is the preferred surgical procedure in paediatric refractory glaucoma. Complication rates are relatively low after ECP; however, large studies with long-term follow-up are needed. ECP may be used in difficult, refractory cases, but it is often used earlier when combined with cataract surgery. Despite limited data on the exact mechanism of action of MP-TLT and a lack of standardization of laser settings, the first data from heterogeneous case series shows that it has a similar efficacy and a better safety profile compared to CW-TSCPC in the medium term. CONCLUSION Although they may lead to sight-threatening complications, both CW-TSCPC and ECP seem effective. ECP appears to be superior to CW-TSCPC in paediatric refractory glaucoma. Unlike ECP combined with cataract surgery, evidence supporting a wider use of CW-TSCPC and MP-TLT in earlier stages of neuropathy is lacking. While it now appears that the safety profile of MP-TLT is superior to that of CW-CPC, robust prospective comparative studies including homogeneous and well-defined cohorts of patients are still needed to confirm an at least comparable efficacy in the long term.
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Affiliation(s)
- Soufiane Souissi
- Department of Vitreoretinal Surgery Adolphe de Rothschild Foundation Paris France
| | - Yannick Le Mer
- Department of Vitreoretinal Surgery Adolphe de Rothschild Foundation Paris France
| | - Florence Metge
- Department of Pediatric Ophthalmology Adolphe de Rothschild Foundation Paris France
| | - Alexandre Portmann
- Department of Pediatric Ophthalmology Adolphe de Rothschild Foundation Paris France
| | | | - Antoine Labbé
- Department of Ophthalmology III Quinze‐Vingts Hospital Paris France
| | - Pascale Hamard
- Department of Ophthalmology III Quinze‐Vingts Hospital Paris France
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Fallico M, Avitabile T, Castellino N, Longo A, Russo A, Bonfiglio V, Parisi F, Furino C, Panozzo G, Scorcia V, Carnevali A, Bandello F, Parodi MB, Cennamo G, Cillino S, Vadalà M, Sunseri Trapani V, Cagini C, Fiore T, Lupidi M, Parravano M, Varano M, Giorno P, Boscia F, Giancipoli E, Eandi C, Le Mer Y, Reibaldi M. Intravitreal dexamethasone implant one month before versus concomitant with cataract surgery in patients with diabetic macular oedema: the dexcat study. Acta Ophthalmol 2021; 99:e74-e80. [PMID: 32588978 DOI: 10.1111/aos.14516] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/26/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To report clinical outcomes of two different timings of intravitreal dexamethasone (DEX) implant administration for prevention of diabetic macular oedema (DME) worsening following cataract surgery. METHODS This multicentre, retrospective study included patients with DME who received an intravitreal DEX implant 1 month before cataract surgery, 'precataract DEX' group, or at the time of cataract surgery, 'concomitant treatments' group. Inclusion criteria were a follow-up ≥3 months and ophthalmological examination with optical coherence tomography (OCT) imaging at baseline (cataract surgery) and throughout follow-up. Anatomical improvement was considered to be a decrease in OCT central subfield (CSF) thickness ≥20% compared to baseline. The primary outcomes were anatomical and functional results at 3 months. RESULTS Two hundred twenty-one patients were included: 136 in the 'precataract DEX' group and 85 in the 'concomitant treatments' group. At 3 months, a reduction of CSF thickness ≥ 20% was found in 7.3% of eyes in the 'precataract DEX group' and in 83.7% of eyes in the 'concomitant treatments' group (p < 0.001), with mean CSF thickness lower in the latter group (371 ± 52 µm versus 325 ± 57 µm, p < 0.001). At 3 months, mean best-corrected visual acuity had improved from baseline in both groups (p < 0.001), with no difference between groups (p = 0. 20). No serious systemic adverse events were reported. CONCLUSION Both approaches prevented a worsening of DME, showing a comparable visual outcome. Dexamethasone (DEX) implant given at the same time as cataract surgery provided a better anatomical outcome.
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Affiliation(s)
- Matteo Fallico
- Department of Ophthalmology University of Catania Catania Italy
- Eye Unit Southampton University Hospital Southampton UK
| | | | | | - Antonio Longo
- Department of Ophthalmology University of Catania Catania Italy
| | - Andrea Russo
- Department of Ophthalmology University of Catania Catania Italy
| | | | | | - Claudio Furino
- Department of Ophthalmology University of Bari Bari Italy
| | - Giacomo Panozzo
- Ophthalmology Unit Bussolengo Hospital Bussolengo Verona Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology University of “Magna Graecia” Catanzaro Italy
| | - Adriano Carnevali
- Department of Ophthalmology University of “Magna Graecia” Catanzaro Italy
| | - Francesco Bandello
- Department of Ophthalmology University Vita‐Salute Hospital San Raffaele Milano Italy
| | | | - Gilda Cennamo
- Department of Public Health University of Naples Federico II Naples Italy
| | - Salvatore Cillino
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section University of Palermo Palermo Italy
| | - Maria Vadalà
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section University of Palermo Palermo Italy
| | - Valentina Sunseri Trapani
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section University of Palermo Palermo Italy
| | - Carlo Cagini
- Division of Ophthalmology Department of Surgery and Biomedical Science S Maria della Misericordia Hospital University of Perugia Perugia Italy
| | - Tito Fiore
- Division of Ophthalmology Department of Surgery and Biomedical Science S Maria della Misericordia Hospital University of Perugia Perugia Italy
| | - Marco Lupidi
- Division of Ophthalmology Department of Surgery and Biomedical Science S Maria della Misericordia Hospital University of Perugia Perugia Italy
| | | | - Monica Varano
- Department of Ophthalmology IRCCS ‐ Fondazione Bietti Rome Italy
| | - Paola Giorno
- Department of Ophthalmology IRCCS ‐ Fondazione Bietti Rome Italy
| | | | | | - Chiara Eandi
- Department of Surgical Science Eye Clinic University of Torino Torino Italy
- Department of Ophthalmology Fondation Ophtalmologique A. De Rothschild Paris France
| | - Yannick Le Mer
- Department of Ophthalmology Fondation Ophtalmologique A. De Rothschild Paris France
| | - Michele Reibaldi
- Department of Ophthalmology University of Catania Catania Italy
- Department of Surgical Science Eye Clinic University of Torino Torino Italy
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Blautain B, Leleu I, Jabbour E, Mer YL. Ischemic stroke and retinal artery occlusion after carotid aneurysm embolization. Radiol Case Rep 2021; 16:701-703. [PMID: 33488902 PMCID: PMC7807205 DOI: 10.1016/j.radcr.2020.12.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 11/25/2022] Open
Abstract
We present the case of a 72-year-old male with a right carotid aneurysm incidentally discovered after an ischemic stroke. After management of the stroke, stent-assisted coil embolization was performed to treat the aneurysm. Two simultaneous and early complications occurred: new ischemic strokes and branch retinal artery occlusions, respectively in the right occipital lobe and in the right eye. Treatment of unruptured carotid aneurysm using stent-assisted coil embolization can lead to severe complications involving both the brain and the retina. Multidisciplinary and close surveillance of patients should be performed to diagnose adverse effects of this endovascular treatment.
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Affiliation(s)
- Benjamin Blautain
- Hôpital Fondation Adolphe de Rothschild, 25, rue Manin, 75019 Paris, France
| | - Igor Leleu
- Centre Hospitalier des Quinze-Vingts, Service II, 28 rue de Charenton, 75012 Paris, France
| | - Elyse Jabbour
- Hôpital Fondation Adolphe de Rothschild, 25, rue Manin, 75019 Paris, France
| | - Yannick Le Mer
- Hôpital Fondation Adolphe de Rothschild, 25, rue Manin, 75019 Paris, France
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9
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Louison S, Gabrielle P, Soudry A, Meillon C, Blanc J, Béal G, Arsène S, Le Mer Y, Berrod J, Kodjikian L, Creuzot‐Garcher C. Perioperative risk of bleeding with antithrombotic agents in macular surgery: a national, prospective, multicentre study. Acta Ophthalmol 2020; 98:e991-e997. [PMID: 32279459 DOI: 10.1111/aos.14434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 03/15/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To compare the risk of haemorrhagic complications in elective macular surgery between patients with no antithrombotic (AT) treatment (defined as patients with no history of AT therapy or who discontinued AT therapy) and patients who continued AT treatment during the surgery. METHODS E-case report forms were prospectively recorded in a database before vitreoretinal surgery and 1 month after. Data on patient characteristics, surgical techniques, haemorrhagic complications and antithrombotic status were collected. Patients with retinal detachment, proliferative diabetic retinopathy and previous retinal haemorrhage were excluded. RESULTS A total of 748 procedures (single procedure in one eye per patient) were performed between January and May 2019. Among them, 202 patients (27.0%) were treated with antithrombotic therapy at the time of surgery: 19.5% with antiplatelet agents (n = 146), 6.3% with anticoagulants (n = 47) including 3.2% (n = 24) patients treated with novel oral anticoagulants, 0.8% (n = 6) with anticoagulants and antiplatelet agents, and 0.4% (n = 3) with heparin. Overall, 92 patients (12.3%) developed one or more haemorrhagic complications, of which 63 (11.5%) and 29 (14.4%) were in the non-AT and AT group, respectively. The multivariate logistic regression model showed no difference between AT treatment groups regarding ocular bleeding complications (odds ratio [OR] 1.2, 95% confidence interval (CI) [0.7-2.2], p = 0.54). CONCLUSION No cases of uncontrolled or severe perioperative haemorrhage in patients continuing antithrombotic agents were reported in this selected population. For the majority of the patients taking antiplatelets or anticoagulants, these agents could be safely continued during macular surgery.
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Affiliation(s)
- Solenne Louison
- Department of Ophthalmology University Hospital Dijon France
| | - Pierre‐Henry Gabrielle
- Department of Ophthalmology University Hospital Dijon France
- Eye and Nutrition Research Group National Scientific Research Council (CNRS) National Institute of Agronomic Research (INRA) University of Burgundy Dijon France
| | - Agnès Soudry
- Department of Clinical Research and Investigation University Hospital Dijon France
| | - Cyril Meillon
- Department of Ophthalmology University Hospital Dijon France
| | - Julie Blanc
- Department of Ophthalmology University Hospital Dijon France
| | - Guillaume Béal
- Department of Anaesthesiology University Hospital Dijon France
| | - Sophie Arsène
- Department of Ophthalmology University Hospital Tours France
| | - Yannick Le Mer
- Department of Ophthalmology Rothschild Ophthalmologic Foundation Paris France
| | | | - Laurent Kodjikian
- Department of Ophthalmology Croix‐Rousse University Hospital Lyon France
| | - Catherine Creuzot‐Garcher
- Department of Ophthalmology University Hospital Dijon France
- Eye and Nutrition Research Group National Scientific Research Council (CNRS) National Institute of Agronomic Research (INRA) University of Burgundy Dijon France
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10
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Eandi CM, De Geronimo D, Giannini D, Polito MS, Tosi GM, Neri G, Le Mer Y, Varano M, Parravano M. Baseline SD-OCT characteristics of diabetic macular oedema patterns can predict morphological features and timing of recurrence in patients treated with dexamethasone intravitreal implants. Acta Diabetol 2020; 57:867-874. [PMID: 32114643 PMCID: PMC7311372 DOI: 10.1007/s00592-020-01504-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/11/2020] [Indexed: 12/31/2022]
Abstract
AIMS To evaluate the timing and spectral-domain optical coherence tomography (SD-OCT) features of diabetic macular oedema (DME) recurrence according to baseline OCT patterns in patients treated with dexamethasone implant (DEX-I). METHODS This is a retrospective observational study (72 eyes/65 patients). Best-corrected visual acuity, timing of DME recurrence, and SD-OCT pattern [intraretinal cysts (IRC), IRC plus subretinal fluid (mixed), external limiting membrane (ELM), ellipsoid (IS/OS) layer integrity] were assessed at baseline and monthly until first DME recurrence. RESULTS Forty-two (58.3%) and 30 (41.6%) DME eyes had an IRC and mixed DME pattern at baseline, respectively. Twenty-four out of thirty mixed eyes (80%) relapsed without subretinal fluid. At baseline, mixed eyes showed similar changes in ELM and IS/OS (60 and 76.6% of eyes, respectively) versus IRC eyes (42.8 and 80.9% of eyes). After DME recurrence, more mixed eyes at baseline showed ELM and IS/OS changes (63.3 and 86.6%) than IRC eyes (50 and 76.2%). 33.3% of mixed eyes had DME recurrence at ≥ 6 months from first DEX-I implant versus 19% of IRC eyes. CONCLUSIONS Mixed DME eyes were treated with DEX-I relapse later and more frequently without subretinal fluid than IRC eyes. SD-OCT characteristics of different DME patterns at baseline can predict morphological features and timing of DME recurrence.
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Affiliation(s)
- Chiara M Eandi
- Department of Surgical Sciences, University of Torino, C. Dogliotti 14, 10126, Turin, Italy.
- Department of Ophthalmology, Jules-Gonin Eye Hospital, University of Lausanne, Fondation Asile des aveugles, Lausanne, Switzerland.
- Department of Ophthalmology, Fondation Ophtalmologique A. De Rothschild, Paris, France.
| | | | | | - Maria Sole Polito
- Department of Surgical Sciences, University of Torino, C. Dogliotti 14, 10126, Turin, Italy
| | - Gian Marco Tosi
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Giovanni Neri
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Yannick Le Mer
- Department of Ophthalmology, Fondation Ophtalmologique A. De Rothschild, Paris, France
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11
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Ducloyer JB, Ivan J, Poinas A, Lebreton O, Bonissent A, Fossum P, Volteau C, Tadayoni R, Creuzot-Garchet C, Le Mer Y, Perol J, Fortin J, Chiffoleau A, Billaud F, Ivan C, Weber M. Does internal limiting membrane peeling during epiretinal membrane surgery induce microscotomas on microperimetry? Study protocol for PEELING, a randomized controlled clinical trial. Trials 2020; 21:500. [PMID: 32513229 PMCID: PMC7278143 DOI: 10.1186/s13063-020-04433-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/19/2020] [Indexed: 11/10/2022] Open
Abstract
Background The epiretinal membrane (ERM) is a degenerative condition associated with age, which can cause loss of vision and/or metamorphopsia. The treatment of symptomatic ERM involves surgical removal including a vitrectomy followed by peeling of the ERM using a microforceps. As the internal limiting membrane (ILM) is adherent to the ERM, it is sometimes removed with it (spontaneous peeling). If ILM remains in place, it can be removed to reduce ERM recurrence. However, it is important to clarify the safety of ILM peeling, while it increases surgical risks and cause histological disorganization of the retina that can lead to microscotomas, may be responsible for definitive visual discomfort. Methods PEELING is a prospective, randomized, controlled, single-blind, and multicentered trial with two parallel arms. This study investigates the benefit/risk ratio of active ILM peeling among individuals undergoing ERM surgery without spontaneous ILM peeling. Randomization is done in the operating room after ERM removal if ILM remains in place. After randomization, the two groups—“active peeling of the ILM” and “no peeling of the ILM”—are compared during a total of three follow-up visits scheduled at month 1, month 6, and month 12. Primary endpoint is the difference in microscotomas before surgery and 6 months after surgery. Patients with spontaneous peeling are not randomized and are included in the ancillary study with the same follow-up visits and the same examinations as the principal study. Relevant inclusion criteria involve individuals aged > 18 years living with idiopathic symptomatic ERM, including pseudophakic patients with transparent posterior capsule or open capsule or lensed patients with age-related cataracts. The calculated sample size corresponds to 53 randomized eyes (one eye/patient) per arm that means 106 randomized eyes (106 randomized patients) in total and a maximum of 222 included patients (116 spontaneous peeling). Discussion ILM peeling is often practiced in ERM surgery to reduce ERM recurrence. It does not impair postoperative visual acuity, but it increases the surgical risks and causes anatomical damages. If active ILM peeling is significantly associated with more microscotomas, it may contraindicate the ILM peeling during primitive idiopathic ERM surgery. Trial registration ClinicalTrials.gov, NCT02146144. Registered on 22 May 2014. Recruitment is still ongoing.
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Affiliation(s)
- Jean-Baptiste Ducloyer
- Department of Ophthalmology, CHU Nantes, Nantes, France.,Clinical Investigation Centre CIC1413, INSERM and CHU Nantes, Nantes, France
| | - Juliette Ivan
- Clinical Investigation Centre CIC1413, INSERM and CHU Nantes, Nantes, France
| | - Alexandra Poinas
- Clinical Investigation Centre CIC1413, INSERM and CHU Nantes, Nantes, France.
| | | | | | - Paul Fossum
- Department of Ophthalmology, CHU Nantes, Nantes, France
| | | | - Ramin Tadayoni
- Ophthalmology Department, Hôpital Lariboisière, AP-HP, Université Paris 7 - Sorbonne Paris Cité, Paris, France
| | | | - Yannick Le Mer
- Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Julien Perol
- Ophthalmology Department, Polyclinique de l'Atlantique, Saint-Herblain, France
| | - June Fortin
- Sponsor Department, CHU Nantes, Nantes, France
| | | | - Fanny Billaud
- Department of Ophthalmology, CHU Nantes, Nantes, France.,Clinical Investigation Centre CIC1413, INSERM and CHU Nantes, Nantes, France
| | - Catherine Ivan
- Department of Ophthalmology, CHU Nantes, Nantes, France.,Clinical Investigation Centre CIC1413, INSERM and CHU Nantes, Nantes, France
| | - Michel Weber
- Department of Ophthalmology, CHU Nantes, Nantes, France.,Clinical Investigation Centre CIC1413, INSERM and CHU Nantes, Nantes, France
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12
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Vandefonteyne S, Caujolle JP, Rosier L, Conrath J, Quentel G, Tadayoni R, Maschi C, Le Mer Y, Dot C, Aknin I, Thariat J, Baillif S. Diagnosis and treatment of peripheral exudative haemorrhagic chorioretinopathy. Br J Ophthalmol 2019; 104:874-878. [PMID: 31645320 DOI: 10.1136/bjophthalmol-2018-313307] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 09/04/2019] [Accepted: 09/15/2019] [Indexed: 11/03/2022]
Abstract
PURPOSE Peripheral exudative haemorrhagic chorioretinopathy (PEHCR) is a rare disorder that is often misdiagnosed. The aim of this study was to better characterise PEHCR and to assess treatment options. MATERIAL AND METHODS Retrospective multicentric chart review. RESULTS Of 84 eyes (69 patients) with PEHCR referred between 2005 and 2017, the most common referral diagnosis was choroidal melanoma (41.3%). Bilateral involvement was found in 21.7% of cases. Haemorrhagic retinal pigment epithelium detachment was the most common peripheral lesion (53.6%). Maculopathy was associated with peripheral lesions in 65.8% of cases. PEHCR lesions were mostly heterogeneous (58.8%) on B-scan ultrasonography. Choroidal neovascularisation was found in 10 eyes (26.3%) out of 38 eyes that underwent fluorescein angiography. Polyps were observed in 14 eyes (58.3%) out of 24 eyes that underwent indocyanine green angiography. Fifty-one eyes were treated (62.2%). Intravitreal injections (IVTI) of antivascular endothelial growth factor (VEGF) were the most used treatment (36.6%) before laser photocoagulation, photodynamic therapy, vitrectomy and cryotherapy. Only vitrectomy improved visual acuity. Most lesions (65.6%) regressed at the last follow-up visit. CONCLUSION In case of PEHCR, multimodal imaging is useful to avoid misdiagnosis, to characterise PEHCR lesions and to guide treatment strategies. Regression of PEHCR lesions was observed in two-thirds of the patients. Vitrectomy improved visual acuity. More than a third of patients underwent anti-VEGF IVTI. Further studies are needed to assess IVTI's efficacy.
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Affiliation(s)
| | | | - Laurence Rosier
- Department of Ophthalmology, Galien Eye Clinic, Centre d'Exploration et de Traitement de la Retine et de la Macula, Bordeaux, France
| | - John Conrath
- Department of ophthalmology, Centre d'Ophtalmologie Monticelli-Paradis, Marseille, France
| | - Gabriel Quentel
- Department of Ophthalmology, Centre d'imagerie et de Laser, Paris, France
| | - Ramin Tadayoni
- Department of ophthalmology, Lariboisière University Hospital, Paris, France
| | - Celia Maschi
- Department of Ophthalmology, Pasteur 2 University Hospital, Nice, France
| | - Yannick Le Mer
- Department of ophthalmology, A. de Rothschild Ophthalmologic Foundation, Paris, France
| | - Corinne Dot
- Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France
| | - Isabelle Aknin
- Department of ophthalmology, Oxford Clinic, Cannes-Juan-les-pins, France
| | - Juliette Thariat
- Department of radiotherapy, Centre François Baclesse / ARCHADE, Caen, France
| | - Stephanie Baillif
- Department of Ophthalmology, Pasteur 2 University Hospital, Nice, France
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13
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Eymard P, Le Mer Y. Long-term functional and anatomical evolution in surgically closed macular holes with internal limiting membrane peeling. Eur J Ophthalmol 2019; 30:1112-1119. [DOI: 10.1177/1120672119860778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: The aim of this study was to describe the long-term evolution of macular retinal thickness and visual acuity in patients who present surgically closed full-thickness macular hole, operated by vitrectomy with internal limiting membrane peeling. Methods: A retrospective observational study of patients operated for full-thickness macular hole with closure of the hole and at least 6 months of post-operative follow-up was performed. All patients had pars plana vitrectomy, peeling of the internal limiting membrane, gas filling and positioning. Comparison of the early post-operative (in the first 5 months) visual acuity and spectral-domain optical coherence tomography-measured macular thickness with late post-operative data (between 6 months and 6 years) was performed. Foveal retinal thickness and temporal and nasal retinal thickness between 1 and 3 mm from the centre were recorded. Results: In total, 35 eyes of 34 patients were included, with an early post-operative measure realized at a mean of 1.8 months and a late measure done at a mean of 25.5 months (7–73 months). Foveal thickness stayed unchanged (282 vs 288 µm), nasal parafoveal thickness remained increased compared to normal and stayed constant (345 vs 345 µm) and temporal parafoveal macular thickness was decreased (313 vs 308 µm) ( p = 0.028). Best-corrected visual acuity was improved by the surgery and the gain increased over time. Conclusion: Internal limiting membrane peeling improves anatomical success of full-thickness macular hole, but this procedure is not without long-term scalable consequences on macular thickness on the temporal quadrant (thinning) as on the nasal quadrant (thickening).
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Affiliation(s)
- Pauline Eymard
- Department of Ophthalmology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Yannick Le Mer
- Department of Ophthalmology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
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14
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Muqit MMK, Velikay-Parel M, Weber M, Dupeyron G, Audemard D, Corcostegui B, Sahel J, Le Mer Y. Six-Month Safety and Efficacy of the Intelligent Retinal Implant System II Device in Retinitis Pigmentosa. Ophthalmology 2018; 126:637-639. [PMID: 30591229 DOI: 10.1016/j.ophtha.2018.11.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 10/30/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
- Mahiul M K Muqit
- Vitreoretinal Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.
| | | | | | | | | | | | - José Sahel
- L'Institut de la Vision, Hopital des Quinze Vingts, Paris, France
| | - Yannick Le Mer
- Department of Ophthalmology, Fondation Ophtalmologique A. De Rothschild, Paris, France
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15
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Benarous A, Le Mer Y. Long-Term Results of Vitrectomy for Macular Holes after Failure of Vitreolysis. Ophthalmologica 2018; 240:14-22. [PMID: 29566375 DOI: 10.1159/000481893] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/02/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE Ocriplasmin injection may close some small-to-medium macular holes associated with vitreoretinal traction. If the treatment fails, does vitrectomy and gas injection yield the same results as primary surgery? MATERIAL AND METHODS We report a retrospective case series study of 3 eyes of 3 consecutive patients operated on a few months after initial intravitreal injection of ocriplasmin and enlargement of the macular hole. The minimal follow-up period after surgery was 18 months. RESULTS Surgery was uneventful in all cases. Vitrectomy, internal limiting membrane peeling, and gas injection allowed closing of the 3 macular holes with a progressive improvement in visual acuity over time. Before ocriplasmin injection, visual acuity ranged from 20/60 to 20/32, after failed ocriplasmin injection from 20/80 to 20/40, and at the final follow-up after 18 months from 20/32 to 20/25. CONCLUSION Vitrectomy with internal limiting membrane peeling leads to closure of macular holes even in cases of prior failure to close them by ocriplasmin injection.
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16
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Le Mer Y. [Artificial retinas]. Rev Prat 2017; 67:591-596. [PMID: 30512724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Yannick Le Mer
- Service d'ophtalmologie (Pr J.-A. Sahel), Fondation ophtalmologique Adolphe-de- Rothschild, Paris, France
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17
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Faure C, Gocho K, Le Mer Y, Sahel JA, Paques M, Audo I. Functional and high resolution retinal imaging assessment in a case of ocular siderosis. Doc Ophthalmol 2013; 128:69-75. [PMID: 24337723 DOI: 10.1007/s10633-013-9421-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 12/05/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE To report new findings in a case of ocular siderosis explored by high resolution angiography and adaptive optics (AO). METHODS We report data on a 40-year-old man with an intraocular foreign body (IOFB) embedded in the sclera after hammering. RESULTS Nine months after this accident, the patient presented with full-field electroretinogram (FF-ERG) abnormalities. Subsequent IOFB extraction was performed. One month after the surgery, high resolution angiography showed for the first time small iron particles all over the inner retinal surface. Spreading of these deposits was followed by inflammatory prepapillary new vessels and venous retinal vasculatis, which spontaneously resolved within a few months. ERG responses became slightly electronegative at this time. Clearance of the iron particles was followed over a year with AO and ERG recording. AO revealed an arterial tropism with a decrease in the amount of particles overtime, which may be consistent with macrophagic activity. CONCLUSION High resolution angiography and AO are new tools, combined with electrophysiology, to better understand ocular siderosis pathophysiology.
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Affiliation(s)
- Céline Faure
- Fondation ophtalmologique Adolphe de Rothschild, 25 rue Manin, 75019, Paris, France,
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18
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Basdekidou C, Wolff B, Vasseur V, Mer YL, Sahel JA. Flat choroidal nevus inaccessible to ultrasound sonography evaluated by enhanced depth imaging optical coherence tomography. Case Rep Ophthalmol 2011; 2:185-8. [PMID: 21720534 PMCID: PMC3124455 DOI: 10.1159/000329539] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Purpose To demonstrate the usefulness of enhanced depth imaging optical coherence tomography (EDI-OCT) in investigating choroidal lesions inaccessible to ultrasound sonography. Methods In a 60-year-old woman with an asymptomatic choroidal nevus, normal OCT was used to observe the macula and EDI-OCT to image the choroidal nevus that was inaccessible to ultrasound. The exact location of the lesion in the choroid and the dimensions of the nevus were measured. Results The lesion was located in the superior macula, and the nevus was homogeneous in its reflectivity. We observed a thickened choroid delineated by the shadow cone behind it, measuring 1,376 × 325 μm in the larger vertical cut and 1,220 × 325 μm in the larger horizontal cut in an image with a 1:1 pixel mapping and automatic zoom. The macular profile and thickness were both normal. Conclusions EDI-OCT appears to be an excellent technique for measuring choroidal nevi and all choroidal lesions accessible to OCT imaging by depicting their exact location in the choroid, their dimensions, and their demarcation from the surrounding healthy tissue, thus allowing for a more efficient and accurate follow-up.
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Tadayoni R, Vicaut E, Devin F, Creuzot-Garcher C, Berrod JP, Le Mer Y, Korobelnik JF, Aout M, Massin P, Gaudric A. A randomized controlled trial of alleviated positioning after small macular hole surgery. Ophthalmology 2010; 118:150-5. [PMID: 21035869 DOI: 10.1016/j.ophtha.2010.04.040] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 04/22/2010] [Accepted: 04/22/2010] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To establish whether the success rate of surgery for small idiopathic macular holes (diameter, ≤ 400 μm) is significantly reduced if facedown positioning is replaced by simply taking care to avoid the supine position. DESIGN Randomized, controlled, parallel-assignment, open-label, interventional, multicenter clinical trial. PARTICIPANTS Sixty-nine patients from 6 specialized vitreoretinal units, randomized into 2 parallel groups and followed up after surgery for 3 months. METHODS All patients underwent pars plana vitrectomy, peeling of any epiretinal membrane, and 17% C₂F₆ gas filling. Patients then were advised randomly to observe either strict facedown positioning for 22 of 24 hours or simply to avoid the supine position for 10 days. MAIN OUTCOME MEASURES The primary outcome measure was the rate of anatomic closure 3 months after surgery. Main secondary measurements included Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity, progression of cataract, and frequency of complications. RESULTS The mean size of macular holes was approximately 300 μm in both groups. Closure rates were more than 90% in both groups: 32 (91.4%) of 34 eyes in the alleviated positioning group versus 32 (94.1%) of 35 eyes in the facedown positioning group (lower margin of 95% confidence interval of difference, -14.88%). The ETDRS scores at 3 months increased in both groups by 10.23 ± 14.64 and 10.52 ± 14.54 letters, respectively. Progression of cataract and the rate of other complications were not significantly different in the 2 groups. CONCLUSIONS The success rate of surgery for idiopathic macular holes of 400 μm or smaller is not significantly reduced if facedown positioning is replaced by simply taking care to avoid the supine position. These macular holes can be treated by streamlined surgery, that is, with no internal limiting membrane peeling and no facedown positioning (only avoidance of the supine position) with a closure rate of more than 90% and a mean gain in visual acuity of more than 2 ETDRS lines at 3 months.
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Affiliation(s)
- Ramin Tadayoni
- Service d'Ophtalmologie, Hôpital Lariboisière, AP-HP, Université Paris Diderot, Paris, France.
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