Follow-up after surgery for hemorrhagic AMD.

INTRODUCTION: The long-term functional results of macular hematoma (MH) surgery in exudative AMD are often limited. The goal of this study was to compare visual outcomes of monthly versus bimestrial follow-up in these patients. METHODS: Retrospective, interventional case series. Population : 21 eyes of 21 patients with SMH associated with exudative AMD. INCLUSION CRITERIA: first SMH associated with exudative AMD, with 1-year postoperative follow-up. EXCLUSION CRITERIA: blood located exclusively underneath the retinal pigment epithelium on OCT imaging, SMH due to different etiology, lost to follow-up, ≤5 postoperative visits and a different surgical protocol as described. Patients were divided into two groups according to the number of postoperative visits (number of intravitreal injections [IVT] combined with the number of consultations, only one visit was recorded when IVT and consultation occurred on the same day) during the 1-year postoperative follow-up: group 1 had ≥11 visits (n=8); group 2 had 6 to 10 visits (n=13). All eyes underwent vitrectomy with subretinal injection of recombinant tissue plasminogen activator, fluid-gas exchange and anti-VEGF intravitreal injection. The main outcome was change in best-corrected visual acuity (BCVA). RESULTS: Considering visual acuity (VA) change between 1-month and 1-year postoperative follow-up examinations, group 1 had statistically significant greater VA changes (logMAR -0.29±0.44 vs logMAR 0.42±0.73; P=0.016; P=0.016). In patients that had exudative recurrences (ER), group 1 received more anti-VEGF IVT than group 2 (P=0.045). CONCLUSION: Our results showed that monthly follow-up, between the IVT series, is highly recommended to preserve postoperative VA in patients undergoing surgery for SMH associated with AMD.

[Isolated patchy perivenular whitening: When white edema of the posterior pole may be vascular in origin but not a retinal artery occlusion]. / Blanc périveinulaire isolé : quand un œdème blanc du pôle postérieur d'origine vasculaire ne rime pas avec oblitération artérielle rétinienne.

OBJECTIVE: To identify cases of non-ischemic retinal vein occlusion (RVO) presenting as isolated patchy perivenular retinal whitening and to describe diagnostic considerations and short-term natural history. MATERIAL AND METHODS: Retrospective observational monocentric case series. Patients monitored in one center between January 2013 and January 2015. Among the 151 patients monitored in our center for retinal vein occlusion, we identified patients presenting with isolated patchy perivenular whitening revealing retinal venous occlusion. RESULTS: Eight patients presenting with isolated perivenular whitening revealing RVO were identified (3.9 %). There were five central retinal vein occlusions, three hemi-retinal vein occlusions and no branch retinal vein occlusions. Initial visual acuity was preserved in five out of eight cases. In all cases, patchy perivenular whitening was isolated, without retinal hemorrhage. Blue monochromatic photographs allowed visualization of patchy perivenular whitening in all cases. Optical coherence tomography (OCT) showed a focal and segmental hyper-reflective area in the inner retinal layers, especially in the inner nuclear layer. One month after diagnosis, atrophy was noted in the retinal layers showing initial hyper-reflectivity. Three cases of our series of eight were initially mistakenly diagnosed as central retinal arterial occlusion. CONCLUSION: The main complication of perivenular whitening is the atrophy of inner retinal layers responsible for paracentral scotomas. The differential diagnosis with retinal arterial occlusion, which may be difficult, is based on the angiographic and OCT features, and their progression.