Predictibility of the efficacy of peripheral iridotomy in primary angle closure: Utility of UBM.

PURPOSE: To assess the utility of UBM in the management of primary angle closure (PAC) and assessing the predictability of peripheral iridotomy (PI) in re-opening the closed angle. DESIGN: Retrospective clinical study. SUBJECTS: Patients with suspicion of PAC. METHODS: This study obtained the consent of all patients and adhered to the Declaration of Helsinki. It was conducted in two ocular imaging centers and based on patients with suspected PAC. Each patient underwent UBM and Visante OCT at each visit, before and after PI when PAC was confirmed. MAIN OUTCOME MEASURE: Irido-corneal angle. RESULTS: Out of 202 eyes (101 patients) with a mean age of 62 years and 69.3% female predominance, we found 186 eyes with PAC. In most cases (77.4%), the iridocorneal angle was open after a single PI at the second visit, and only 14% eyes remained closed at the third visit, regardless of any additional treatment performed (complementary PI, iridoplasty, surgical lens extraction). Mechanisms involved in persistent angle closure after PI were: imperforate PI (45.2% of eyes), iris plateau syndrome (8.6% of eyes), significant lens vaulting (30.9% of eyes) and mixed mechanisms (2.3% of eyes). CONCLUSION: PI remains effective as a first-line treatment in most cases of PAC, even when associated with mechanisms other than pupillary block. Nevertheless, the PI must be completely patent, and UBM can help in understanding underlying mechanisms, hence guiding the treatment in these eyes.

[Treatment of exudative age-related macular degeneration: Consensus of French experts for first-line treatment selection and the importance of long-term risk/benefit ratio]. / Consensus d'experts français sur les critères de choix d'un traitement de 1re intention dans la DMLA néovasculaire et importance du ratio bénéfice/risque à long terme.

Choosing a first-line treatment to optimize long-term outcomes is a major challenge for treating patients with neovascular age-related macular degeneration (AMD). The development of several new molecules makes it critical to identify the relevant factors to consider so as to provide an optimal risk-benefit ratio when initiating a treatment in naïve patients with neovascular AMD. This paper proposes a consensus established with the Delphi method (which includes a gradation in a consensus based on an analysis of the convergence rate of answers) to provide criteria that guide the ophthalmologist's decision for treatment initiation and follow-up in neovascular AMD patients. Fourteen questions were submitted to 93 French retina experts. Thirteen (93%) of the questions reached a consensus (≥50% of answers consensual). The criteria recommended to take into account were both efficacy and onset of action of the molecules, their safety, and the ability to decrease injection frequency. The primary criterion of expected efficacy of a molecule is a combination of the gain in visual acuity and resorption of retinal fluid. With regard to safety, experts recommend tighter follow-up for molecules currently in development, and at every scheduled visit, patients should be screened to identify early any potential adverse effects such as intraocular inflammation, retinal vasculitis or vascular occlusion. Experts also emphasize the importance of the packaging of the biological, with a preference toward prefilled syringes. Injection frequency is a key factor, and the authors recommended aiming for a maximal injection interval of 12 to 16 weeks. The stability of that maximum interval is also an important factor to consider in treatment selection.

[Role of in vivo confocal microscopy in irido-corneo-endothelial syndromes]. / Apport de la microscopie confocale in vivo dans les syndromes irido-cornéo-endothéliaux.

INTRODUCTION: In vivo confocal microscopy (IVCM) is an increasingly utilized tool in studying complex corneal and anterior segment pathologies. We illustrate the role of this imaging technique in the irido-corneo-endothelial (ICE) syndromes through a case report. CASE REPORT: A 47-year-old woman presented unilateral decreased vision associated with ocular hypertension and peripheral anterior synechiae. Slit lamp examination of the cornea was unremarkable but IVCM showed pleomorphism and polymegathism of the corneal endothelium and highly reflective nuclei resulting in an epithelial-like cell morphology. This appearance led to the diagnosis of ICE syndrome. DISCUSSION: Confocal microscopic findings in ICE syndromes are similar to histopathologic findings. This technique may be for a useful diagnostic adjunct in ICE syndromes by revealing specific characteristics, particularly in difficult diagnostic situations, such as when corneal edema impedes specular microscopy or when the iris fails to demonstrate pathognomonic anomalies.