Approche diagnostique et thérapeutique de la vasculopathie polypoïdale choroïdienne. Recommandations de la Fédération France Macula.

PURPOSE: To update the medical literature on the diagnostic and therapeutic approach to polypoidal choroidal vasculopathy (PCV) and to propose a treatment algorithm in agreement with French market approval, supported by the France Macula Federation (FFM). METHODS: Literature review and expert opinion. RESULTS: The diagnosis of PCV is based on multimodal imaging, including indocyanine green angiography (ICGA), which is considered the gold standard for the diagnosis of PCV. Regarding the therapeutic management of PCV, the FFM recommends treating PCV first-line either by monotherapy with intra-vitreal anti-vascular endothelial growth factor (anti-VEGF) injections, or by a combined treatment of photodynamic therapy (PDT) with Verteporfin and intra-vitreal anti-VEGF injections, depending on the location of the PCV.

Prognostic significance of morphotypes in canine lymphomas: A systematic review of literature.

Correlation between morphotypes and prognosis of canine lymphomas presented discordant results in literature, leading to some dilemma for application in clinical practice. The aim of this study was to present a systematic review of literature on the prognostic significance of morphotypes in canine lymphomas. Standardized Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria were applied. Retrospective and prospective studies were included. Level of evidence was determined for each study. Some acceptable evidence suggested a significant prognostic impact of morphotypes in canine lymphomas. However, the evidence is not sufficiently robust to determine with precision the most appropriate classification scheme. Updated Kiel and World Health Organization (WHO) classifications seem to remain the most appropriate classification systems with regards to the number of available studies and their levels of evidence. Limitations included lack of randomized control trial, and relative lack of prospective studies available. Current recommended classification of canine lymphoma is the systematic determination of morphotype in each new case. The Updated Kiel and the WHO classifications adapted to dog both remain the schemes with the most valuable interest. Prospective studies in larger population, and international consensus to define precisely each morphotype, are warranted, with application of standardized staging method and treatment.

Retrospective evaluation of blood copper stable isotopes ratio 65 Cu/63 Cu as a biomarker of cancer in dogs.

Previous studies in humans with breast, colorectal or liver cancer showed that neoplasia was associated with a modification of the blood ratio between 65 Cu and 63 Cu (∂Cu). The aim of the present study was to compare the blood ∂Cu of dogs with cancer to healthy controls or dogs with non-oncologic disease. One hundred and seventeen dogs were included in the study (35 dogs with cancer, 33 dogs with non-neoplastic disease, and 49 healthy controls). The ∂Cu of dogs with cancer was significantly lower than the ratio of healthy controls (P < 0.0001) but not significantly different from dogs with non-oncologic disease. Six dogs with lymphoma were also evaluated after they achieved clinical remission and five out of six had an increase of ∂Cu. Further studies are warranted but these results suggest that ∂Cu could help in the diagnosis of cancer in a controlled clinical context, and may be a potential biomarker for the follow-up of cancer.

[Ranibizumab and exudative age-related macular degeneration: 5-year multicentric functional and anatomical results in real-life practice]. / Ranibizumab et dégénérescence maculaire liée à l'âge exsudative : analyse multicentrique à 5ans des résultats fonctionnels et anatomiques en pratique clinique réelle.

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.

Probable cutaneous hypersensitivity to carboplatin single-agent chemotherapy in a dog.

Carboplatin is usually a well-tolerated drug and has many applications in veterinary oncology. The side effects of carboplatin described in the veterinary literature include myelotoxicity, nephrotoxicity, digestive and appetite disorders. In 114 dogs treated by single-agent chemotherapy with carboplatin, we observed a rate of non-haematological toxicities of 19·3% (personal observation). This case report describes the first case of cutaneous delayed-hypersensitivity to carboplatin in a dog, diagnosed according to the official ABON-system, which determines a causal association between a suspected product and a reported reaction (A=probable, B=possible, O=unclassifiable and N=unlikely), and an experimental intradermal skin test. Antihistamines were used to treat the reaction, and future carboplatin treatments were adjusted by premedication with corticosteroids, prolonged infusion and a reduction of 20% of the first dose of carboplatin. No further reactions were noted during the following treatments.

Retinal photocoagulation for proliferative sickle cell retinopathy: a prospective clinical trial with new sea fan classification.

PURPOSE: To compare the clinical outcome of stage III proliferative sickle cell retinopathy (PSR) treated by peripheral retinal scatter photocoagulation to natural course disease. METHODS: Long-term follow-up of 101 patients enrolled in a prospective trial of photocoagulation for PSR has been completed. Among 202 eyes of 101 patients enrolled at the University Eye Clinic of Créteil, 73 eyes showed a stage III PSR, which the authors further divided into five new grades (A, B, C, D, E) considering size, hemorrhage, fibrosis, and visible vessels. Grading was based on a three-mirror fundus examination, 360 degrees color photographs, and fluorescein angiography. Mean follow- up was 4 years. RESULTS: Thirty-eight treated eyes and 35 untreated eyes were included in this study. The evolution was not statistically significant between treated and untreated groups concerning flat sea fan <1 MPS disc area (grade A) or elevated sea fan with partial fibrosis (grade C). Progression and regression were compared between the two groups for grade B, resulting statistically significant (p<0.05). Nine complications (13%) were observed, which only occurred in untreated patients with elevated sea fan and hemorrhage (grade B) or complete fibrosed sea fan with well defined vessels (grade E) (p<0.05). CONCLUSIONS: These data suggest that patients with grade A or C new sea fan classification should not be initially treated but observed.

[Retinal vein occlusion and carotid Doppler imaging]. / Occlusions veineuses rétiniennes et échographie-Doppler carotidienne.

PURPOSE: To investigate retinal vein occlusion with B-mode ultrasonography carotid and color Doppler imaging. METHODS: In 223 patients (225 eyes) presenting with retinal vein occlusion, we retrospectively investigated vascular risk factors (hypertension, diabetes, hyperlipidemia, cardiovascular history, smoking, and glaucoma), standard laboratory tests, and color Doppler imaging of the carotid artery. RESULTS: The data from 106 women (47.54%) and 117 men (52.46%), with a mean age of 65 years, were studied, with 169 patients presenting a central retinal vein occlusion (CRVO) and 56 a branch retinal vein occlusion (BRVO). Thirteen patients (6%) had significant carotid artery stenosis (>=70%), which was the single etiology. Forty patients (18%) had nonsignificant carotid artery stenosis (<70%) with a risk of embolism production. Such carotid artery lesions found in color Doppler imaging in the RVO investigations were significantly more frequent in older patients (>65 years) who presented at least two RVO risk factors (p<0.001). CONCLUSION: This study has shown the the advantages of carotid Doppler imaging in retinal vein occlusion.

[Tarsomarginal graft. Indication and results in palpebral surgery]. / La greffe tarso-marginale: indication en chirurgie réparatrice de paupière.

A tarsomarginal graft is indicated in eyelid reconstructive surgery particularly after tumor resection. We reported the results of a retrospective study during the past 13 years with 58 grafts. We found a predominance of basal cell carcinomas localised in the lateral third portion of the lid (42%) and in the lower eyelid (76%). The mean size was 14mm for the tumor and 9.81mm for the graft. Grafts were used to cover a defect larger than 5mm. Complications were rare, and mainly involved suture looseness. The Hubner technique gave good results; repairing the eyelid without having to make a tarsorraphy and providing good cosmetic results. The graft must be covered by a skin flap.

[Dermis fat graft. Use of surgical reconstruction of the cavities]. / La greffe dermo-graisseuse. Utilisation en chirurgie de reconstruction des cavités.

Dermis fat graft is a surgical technique that is nowadays well accepted for the reconstruction of the orbital cavities. The authors report the results and the follow-up of 17 dermis fat grafts carried out at the Reims Hospital between March 1(st), 1987 and December 31(st)1999. They explain the modalities of the technique, its major indications and the possible complications. At Reims, the dermis fat graft is mainly done to resolve intraorbital implant extrusions.