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1.
J Fr Ophtalmol ; 39(8): 668-674, 2016 Oct.
Article in French | MEDLINE | ID: mdl-27609025

ABSTRACT

PURPOSE: The goal of this study was to evaluate five year functional and anatomical outcomes of wet AMD patients treated with ranibizumab according to a pro re nata (PRN) regimen in real-life practice. METHODS: A retrospective, multicentric chart review of 201 eyes of 201 patients who underwent their first ranibizumab intravitreal injection (IVT) between January 1, 2007 and December 31, 2008 was performed. Best-corrected visual acuity (BCVA), central macular thickness (CMT) on SD-OCT, number of IVT and follow-up visits were collected at baseline and during the entire follow-up period of 5 years. RESULTS: Mean BCVA at baseline was 52.3±16.5 letters. Mean BCVA change from baseline was respectively +2.8, +2.5, +1.8, -0.6 at 1, 2, 3, 4 years of follow-up. At year 5, 43% of eyes had a stable or improved letter score (≥0 letter gain), whereas 29% declined by 15 letters or more, with an overall significant mean decline of 2.8 letters (P<0.05). No correlation was observed between final visual outcome and age, baseline BCVA, type of neovascularization, naive status, number of IVT or number of follow-up visits. On SD-OCT, mean CMT was 293±96µm at baseline and was significantly reduced compared to baseline at each year end-point (P<0.005). The mean number of IVT was 15±10.4 at year 5, with 55% of eyes still being under active treatment. CONCLUSION: PRN ranibizumab in real-life practice improved or stabilized visual acuity over 4 years. During the 5th year, progressive decline of visual acuity was observed.


Subject(s)
Angiogenesis Inhibitors/administration & dosage , Ranibizumab/administration & dosage , Visual Acuity , Wet Macular Degeneration/drug therapy , Wet Macular Degeneration/pathology , Aged , Aged, 80 and over , Angiogenesis Inhibitors/adverse effects , Female , Fundus Oculi , Humans , Intravitreal Injections , Male , Practice Patterns, Physicians' , Ranibizumab/adverse effects , Retrospective Studies , Treatment Outcome , Visual Acuity/drug effects , Wet Macular Degeneration/diagnostic imaging , Wet Macular Degeneration/physiopathology
2.
J Fr Ophtalmol ; 26(9): 905-10, 2003 Nov.
Article in French | MEDLINE | ID: mdl-14631274

ABSTRACT

PURPOSE: To report and analyze the circumstances of uveal melanoma detection. METHODS: The records of 143 consecutive patients diagnosed in the Ophthalmology Department of Gustave Roussy Institute between September 1994 and September 2001 were analyzed. The study included 66 females and 77 males, aged from 21 to 91 years (mean, 62.75 years). RESULTS: The first symptom was decreased visual acuity in 37% of cases. In 34.9%, there was no functional sign and a systematic fundus exam provided the diagnosis. Of the 143 patients, 18.8% presented alteration of the visual field or scotoma, 9.9% complained of phosphenes, 9% complained of metamorphopsia, and 6.5% complained of floaters. In 5.5% of cases, there was documented tumor growth. In 2%, the presence of extrascleral exteriorization was the first sign. At the time of diagnosis, anterior tumors tended to be significantly larger than posterior tumors (p<0.007). Smaller lesions were significantly associated with a systematic detection of the tumor (p<0.005). Liver metastasis occurred more frequently with ciliary body melanomas (p<0.001), which were more frequently the largest lesions. CONCLUSION: These results emphasize the importance of early detection of uveal melanoma. We recommended frequent fundus examination after pupil dilatation.


Subject(s)
Choroid Neoplasms/diagnosis , Melanoma/diagnosis , Uveal Neoplasms/diagnosis , Adult , Age Distribution , Aged , Aged, 80 and over , Choroid Neoplasms/complications , Choroid Neoplasms/epidemiology , Ciliary Body , Diagnosis, Differential , Female , France/epidemiology , Humans , Liver Neoplasms/secondary , Male , Melanoma/complications , Melanoma/epidemiology , Middle Aged , Ophthalmoscopy , Phosphenes , Prognosis , Retrospective Studies , Scotoma/etiology , Sex Distribution , Time Factors , Uveal Neoplasms/complications , Uveal Neoplasms/epidemiology , Vision Disorders/etiology , Visual Acuity , Visual Fields
3.
J Fr Ophtalmol ; 25(4): 399-403, 2002 Apr.
Article in French | MEDLINE | ID: mdl-12011745

ABSTRACT

PURPOSE: To investigate the outcome of irradiation of complicated choroidal hemangiomas in Sturge-Weber syndrome. PATIENTS AND METHODS: The charts of 6 patients (7 eyes) with Sturge-Weber syndrome and choroidal hemangiomas were reviewed. An exudative retinal detachment was the indication for treatment in all cases. The mean age of the 6 patients was 13 years (range, 4 to 20 years). The minimum follow-up time was 1 year. Patients were checked for initial and final best-corrected visual acuity, fundus examination, fluorescein angiography, and tumor thickness on B-scan ultrasonography. The patients were treated with radiotherapy. A total dose of 20 Grays was applied to 7 eyes: 2 with a circumscribed choroidal hemangioma underwent proton therapy and 5 with diffuse hemangioma were treated by external beam irradiation. RESULTS: Complete resolution of the subretinal fluid was achieved in all cases with the tumor height decreased. Visual acuity improved to 1 line or more in 5 eyes and remained stable in 2 eyes. Two cases that underwent proton therapy developed radiation retinopathy. CONCLUSION: External beam radiation is an effective and safe option in the management of choroidal hemangiomas complicated by retinal detachment. Based on our experience, proton therapy should be reserved for sporadic circumscribed choroidal hemangioma.


Subject(s)
Choroid Neoplasms/radiotherapy , Hemangioma/radiotherapy , Sturge-Weber Syndrome/radiotherapy , Adolescent , Child , Child, Preschool , Female , Humans , Male , Radiotherapy/adverse effects , Radiotherapy Dosage , Treatment Outcome
4.
J Fr Ophtalmol ; 25(3): 240-5, 2002 Mar.
Article in French | MEDLINE | ID: mdl-11941249

ABSTRACT

PURPOSE: Retinal detachment (RD) is a major complication of cataract surgery, which can be treated by either primary vitrectomy without indentation or the scleral buckling procedure. The aim of this study is to compare the results of these two techniques for the treatment of pseudophakic RD. PATIENTS AND METHODS: The charts of 40 patients (40 eyes) treated with scleral buckling for a primary pseudophakic RD were retrospectively studied and compared to the charts of 32 patients (32 eyes) treated with primary vitrectomy without scleral buckle during the same period by the same surgeons. To obtain comparable samples, patients with giant retinal tears, vitreous hemorrhage, and severe preoperative proliferative vitreoretinopathy (PVR) were not included. Minimal follow-up was 6 months. RESULTS: The primary success rate was 84% in the vitrectomy group and 82.5% in the ab-externo group. Final anatomical success was observed in 100% of cases in the vitrectomy group and in 95% of cases in the ab-externo group. Final visual acuity was 0.5 or better in 44% of cases in the vitrectomy group and 37.5% in the ab-externo group. The duration of the surgery was significantly lower in the ab-externo group, whereas the hospital stay tended to be lower in the vitrectomy group. In the vitrectomy group, postoperative PVR developed in 3 eyes and new or undetected breaks were responsible for failure of the initial procedure in 2 eyes. CONCLUSION: Primary vitrectomy appears to be as effective as scleral buckling procedures for the treatment of pseudophakic RD.


Subject(s)
Pseudophakia/complications , Retinal Detachment/surgery , Scleral Buckling , Vitrectomy/methods , Aged , Female , Fluorocarbons/administration & dosage , Humans , Male , Middle Aged , Postoperative Complications , Retrospective Studies , Time Factors , Visual Acuity
5.
J Fr Ophtalmol ; 25(10): 1032-5, 2002 Dec.
Article in French | MEDLINE | ID: mdl-12527827

ABSTRACT

Diffuse uveal melanocytic proliferation is a rare paraneoplastic syndrome resulting in rapid bilateral visual loss in patients with systemic carcinoma, caused by proliferation of benign melanocytes within the choroid and the ciliary body. More often visual impairment is due to retinal detachment and cataract. The authors report two cases of presumed diffuse uveal melanocytic proliferation. The first patient was a 74-year-old man with a history of colic carcinoma and hemangioendothelioma of the liver who presented with bilateral multiple nevi of the choroid and extrascleral melanic nodule. The second patient was a 59-year-old woman who presented bilateral multiple nevi of the choroid and a history of carcinoma of the thyroid treated by thyroidectomy 2 years before. There was no evidence of systemic melanoma in either patient. Our two patients showed slow progression with no visual impairment and a longer survival than those described in the literature.


Subject(s)
Melanocytes/pathology , Paraneoplastic Syndromes/pathology , Uvea/pathology , Aged , Cell Division , Female , Humans , Male , Middle Aged
6.
J Fr Ophtalmol ; 24(8): 854-9, 2001 Oct.
Article in French | MEDLINE | ID: mdl-11894538

ABSTRACT

Macular edema is frequently responsible for loss of central vision in patients affected with retinitis pigmentosa (RP). This macular edema can be treated with acetazolamide. Our purpose was to evaluate optical coherence tomography (OCT) examination in the follow-up of macular edema in RP. In addition, we tried to evaluate the minimal efficient dose of acetazolamide, using means other than fundus examination or fluorescein angiography. We report the cases of 5 patients affected with typical retinitis pigmentosa and fundus appearance of macular edema. These patients received oral acetazolamide treatment (500 mg/d). The OCT examinations were performed before and during treatment, which allowed us to demonstrate, quantify and monitor the progression of macular edema during treatment. OCT appears to be a useful tool in the follow-up of patients affected with macular edema and RP. This noninvasive examination contributes to improving our strategy in treating patients.


Subject(s)
Macular Edema/pathology , Macular Edema/therapy , Retinitis Pigmentosa/complications , Tomography , Adult , Female , Follow-Up Studies , Humans , Macular Edema/etiology , Male , Middle Aged
7.
Graefes Arch Clin Exp Ophthalmol ; 239(10): 747-51, 2001 Oct.
Article in English | MEDLINE | ID: mdl-11760035

ABSTRACT

UNLABELLED: Interesting results have been reported on the use of pars plana vitrectomy with adventitial sheathotomy for the decompression of branch retinal vein occlusions (BRVO). Recent onset BRVO responsible for a visual acuity of 20/40 or less have been estimated to be good candidates for this procedure. We report on the results of the prospective evaluation of three eyes (in three patients) with recent onset BRVO which underwent surgical decompression. Three men, aged 40, 50, and 68 years presenting with BRVO for 4, 4, and 3 weeks respectively, underwent surgical decompression. Initial visual acuity was 20/80, 20/80, and 20/200. After 11, 10, and 9 months follow-up, visual acuity was 20/80, 20/200, and 20/200. In two eyes, an increase of the area of retinal non-perfusion was treated with peripheral laser photocoagulation. No cataract, retinal tears or retinal detachment were observed. CONCLUSION: although feasible, sheathotomy did not lead to a significant visual improvement in our patients. Dissection of the arteriovenous crossing could have induced vascular trauma. Furthermore, vitrectomy with posterior hyaloid detachment alone could be of benefit in the treatment of branched retinal vein occlusions. A prospective randomised trial is needed to assess the effectiveness and the safety of this procedure and to determine the best candidates for surgery.


Subject(s)
Decompression, Surgical/methods , Ophthalmologic Surgical Procedures , Retinal Vein Occlusion/surgery , Adult , Aged , Fluorescein Angiography , Humans , Male , Middle Aged , Treatment Outcome , Visual Acuity
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