Reliability of self-measurement of visual acuity in AMD patients with two electronic devices based on the ETDRS chart: A randomized study.

INTRODUCTION: Age-related macular degeneration (AMD) requires continuous visual acuity (VA) monitoring, increasing the burden on the health care system. Self-measurement VA tests are available on various devices. However, none of them have been based on an internationally validated benchmark chart, such as that of the Early Treatment Diabetic Retinopathy Study (ETDRS). The goal of this study was to assess the reliability of two digitized ETDRS charts adapted to two electronic devices for self-measurement of VA. MATERIAL AND METHODS: A prospective, single-center, 1:1 randomized, two-arm, parallel group trial was conducted. The main objective was to compare VA variation as conventionally measured on a 4-m ETDRS chart versus self-measured with digitized ETDRS charts in patients treated for AMD. At each visit, conventional measurement and patient self-measurement, either on a computer at 80-cm (arm 1) or on a tablet at 40-cm (arm 2), were performed. RESULTS: Eighty patients were included (25 men, 55 women, mean age 81.3±7.4 years). No significant differences were observed between VA variation, conventionally measured and self-measured on a computer (arm 1; P=0.914) or tablet (arm 2; P=0.913). CONCLUSION: These results confirm the reliability of these two methods for self-measurement of VA, and will lead to the development of a wider "telemedicine" project extended to self-measurement of VA in various pathologies.

Phenotypic expression of diabetes secondary to a T14709C mutation of mitochondrial DNA. Comparison with MIDD syndrome (A3243G mutation): a case report.

OBJECTIVE: To analyze the clinical and biochemical features of a recently described point mutation of mitochondrial DNA associated with diabetes. This mutation, characterized by a T14709C transition of a highly conserved nucleotide in the region coding for the glutamic acid tRNA, is heteroplasmic. RESEARCH DESIGN AND METHODS: The phenotypic expression in the insulin-requiring diabetic proband from the pedigree was compared to that of diabetic probands from three families with the classic A3243G mtDNA mutation (maternally inherited diabetes and deafness [MIDD] syndrome). The same investigations to evaluate pancreatic neurosensorial and muscle involvement were performed in all four patients. RESULTS: The natural courses of the diabetes and the hearing defects were not different between the two mutations. The patient with the 14,709 mutation, however, exhibited a milder alteration of pigmentary epithelium of retina and a much more severe muscle involvement, as attested by the clinical expression and the concurrent anomalies of muscle energy production evidenced by 31P magnetic resonance spectroscopy, confirming the profound impairment of oxidative processes. CONCLUSIONS: This novel mutation has to be added to the other known mtDNA anomalies in order to ascribe some diabetes suspected to arise from mitochondrial defects to this nosological framework.

[Endogenous bacterial endophthalmitis. Report of 3 cases]. / Endophtalmie bactérienne endogène. A propos de trois observations.

Since the antibiotic era, endophthalmitis has been a rare complication of bacterial septicemia. The authors report hereby 3 cases of endogenous bacterial endophthalmitis. Both eyes were involved in one case. Causative bacteria were identified in blood. Cultures were positive respectively for Streptococcus pneumoniae, Staphylococcus aureus and Klebsiella pneumoniae. All patients received intravenous antibiotherapy, once intravitreal antibiotic was injected. Clinical manifestations were three times panophthalmitis with dramatic course. In one case, only the anterior segment was involved. The course became complicated with a cataract, but the patient finally recovered. Although several clinical types with distinct prognoses can be defined, endogenous bacterial endophthalmitis remains a devastating situation. Treatment is controversial because of the uncertainty about the value of intravitreal antibiotics and vitreous surgery.

[Bilateral serous detachment of neuroepithelium of the posterior pole disclosing acute leukemia]. / Décollement séreux bilatéral du neuroépithélium du pôle postérieur révélant une leucémie aiguë.

A 51 year-old woman presented with sudden loss of vision secondary to serous neuroretinal detachments of both maculas. Fluorescein angiography revealed multiple hyperfluorescent pin-point dots in the early phases. The areas of fluorescein hyperfluorescence became more diffuse as dye leaked into the subretinal space. The diagnostic of acute monoblastic leukemia was made. Following treatment, her vision improved. Fundus examination at that time showed resolution of the bilateral serous retinal detachment. She died one month after the onset of visual complaints and autopsy was refused. There have been 14 previous reports of acute leukemia with serous retinal detachment. In most cases, retinal detachment occurred as the presenting sign or during relapse of the systemic disease. It was often bilateral and located in the posterior pole. Histopathologic studies showed leukemic infiltration of the choroid with areas of degeneration and proliferation of the retinal pigment epithelium. Angiographic findings are similar to what is observed in choroidal ischemia. The relationships with macular serous retinal detachment and choriocapillaris occlusion are discussed.