Intravitreal dexamethasone implant versus anti-VEGF injection for treatment-naïve patients with retinal vein occlusion and macular edema: a 12-month follow-up study.

PURPOSE: The objective of his study was to compare the visual and anatomical outcomes in treatment-naïve patients with macular edema secondary to retinal vein occlusion after intravitreal injections of dexamethasone implants (DEX) and anti-VEGF. METHODS: One hundred two patients (64 in the anti-VEGF group, 38 in the DEX group) without previous treatment were included in this multi-center retrospective study and evaluated at baseline and 1, 3, 6, and 12 months after the onset of treatment. Patients were defined as "good responders" if central macular thickness (CMT) was less than or equal to 250 µm in TD-OCT or 300 µm in SD-OCT after the injections. RESULTS: At month 3 (n = 102), BCVA had increased significantly, by 0.1 ± 0.3 logMAR in the anti-VEGF group (p = 0.04) and 0.4 ± 0.4 logMAR in the DEX group (p < 0.001); the difference between the two groups was statistically significant (p = 0.007). CMT decreased significantly, by 138 ± 201 µm (-19 %, p < 0.001) in the anti-VEGF group and 163 ± 243 µm (-21 %, p < 0.001) in the DEX group. After 3 months, five patients (13 %) in the DEX group and 20 (31 %) in the anti-VEGF group (p < 0.001) changed treatment. Among the 77 patients who did not switch from their initial treatment, no significant functional or anatomical difference between the two groups was observed at months 6 and 12. Elevation of intraocular pressure > 21 mmHg was more frequent in the DEX group (21 %) than in the anti-VEGF group (3 %, p = 0.008). CONCLUSIONS: Visual acuity recovery was better in the DEX group than in the anti-VEGF group at month 3, but with no difference in CMT. In patients who did not change treatment, the long-term anatomical and visual outcome was similar between the DEX and anti-VEGF groups.

[Retinal macroaneurysms and macular hemorrhages: report of five cases]. / Macro-anévrismes rétiniens et hémorragies maculaires: à propos de 5 cas.

Retinal macroaneurysm is an uncommon condition, found mainly in hypertensive women over age 60. We report clinical observations in five cases of complicated retinal macroaneurysms. These were all hypertensive women with a mean age of 80.2 years. All retinal macroaneurysms were located in a temporal distribution (superior branch in 80 % of cases), proximal to the third bifurcation, and presented with macular hemorrhage. 4 of the 5 patients were treated surgically by posterior vitrectomy, and one underwent a subretinal injection of recombinant tissue plasminogen activator and gas tamponnade. Functional results were variable. Retinal atrophy secondary to the toxicity of the hemorrhage was observed in two cases. One macular hole was noted.

[Incidence of endophthalmitis after intravitreal injection: is antibioprophylaxis mandatory?]. / Incidence de l'endophtalmie après injection intravitréenne : peut-on se passer de l'antibioprophylaxie ?

INTRODUCTION: Endophthalmitis is the most dreaded complication after intravitreal injection. With the rise of antiangiogenics their rate is getting higher each year. The use of antibioprophylaxis is controversial. We tried to evaluate the impact of antibioprophylaxis on intravitreal injection endophthalmitis incidence. METHODS: All patients who received intravitreal injections between January 2007 and October 2012 were included in this retrospective study. Until June 2012 all patients had antibiotics the days following the injection. From July 2012 the antibiotic was replaced by an antiseptic immediately after the injection. RESULTS: An overall number of 11,450 injections were performed. The overall rate of endophthalmitis was 6/11,450 (0.052%). The incidence of endophthalmitis in the group with antibiotics was 3/10,144 injections (0.03%), 2 were culture proven (0.02%). The incidence in the group without antibiotics was 3/1306 (0.23%). The difference was significant (P=0.024). CONCLUSION: The incidence of endophthalmitis post-intravitreal injections seems to be lower when using antibiotics. However, a prospective study is mandatory to draw more robust conclusions.

[Relationship between intravitreal anti-VEGF therapy and subretinal hemorrhage in patients with exudative age-related macular degeneration]. / Relation entre injection intravitréenne d'anti-VEGF et hématome sous-rétinien chez des patients atteints de dégénérescence maculaire liée à l'âge exsudative.

PURPOSE: To assess and compare frequencies and incidence rates of subretinal hemorrhage (SRH) after intravitreal anti-VEGF injections and spontaneous SRH in patients with exudative age-related macular degeneration (AMD). PATIENTS AND METHODS: This retrospective monocentric study included 1079 patients followed for exudative AMD in the ophthalmology department of the university hospital of Dijon from January 2007 to July 2012. For each SRH occuring during this period, the number of previous treatments with intravitreal anti-VEGF was determined, as well as the time between the last injection and the hemorrhage. The SRH was considered as an adverse effect of the anti-VEGF injection if it occurred within 2 months after the last IVT (post-IVT SRH). Frequencies and incidence rates of post-IVT SRH and spontaneous SRH were calculated. RESULTS: Sixty-six SRH's occurred during the study period with a total frequency of 6.12% (CI95% [4.69-7.55]). Frequencies of spontaneous and post-IVT SRH were respectively 5.65% (CI95% [4.28-7.03]) and 0.46% (CI95% [0.06-0.87]), representing a 12.2 ratio. Post-IVT SRH incidence was 8.3/1000 patient-years (CI95% [1.0-15.5]) and the spontaneous SRH incidence rate was 11.6/1000 patient-years (CI95% [8.3-14.8]), (P=0.472). The incidence rate ratio was 0.72 (CI95% [0.29-1.78]). CONCLUSION: This study did not show a statistically significant change in the incidence of SRH after intravitreal anti-VEGF therapy. The benefit/risk ratio of intravitreal anti-VEGF injections for exudative AMD remains high.

[Treatment of high myopic choroidal neovascularisation with intravitreal bevacizumab]. / Traitement des néovaisseaux choroïdiens du myope fort par injection intravitréenne de bevacizumab.

PURPOSE: To evaluate the safety and efficacy of intravitreal bevacizumab (IVB) in the treatment of high myopic choroidal neovascularization (CNV). MATERIALS AND METHODS: Retrospective study of 16 eyes of 16 patients with high myopic choroidal neovascularization treated with first-line IVB (1.25mg/0.05mL) with a one-year follow-up. All patients underwent a complete baseline (M0) ophthalmologic examination, including the measurement of best corrected visual acuity (BCVA), biomicroscopic and fundus examination, fluorescein and indocyanine green angiography, and optical coherence tomography. Patients were followed monthly. Additional IVB was administered when persistent or additional retinal exudation was observed. The main study parameters were visual acuity at 1, 6 and 12 months and the progression of exudation on OCT and angiography. RESULTS: Mean age was 63±14 years and spherical equivalent was -15.4±7.4 diopters. Baseline BCVA was 0.75±0.5 logMAR. Mean follow-up was 15±2 months. The average number of IVB was 2.4±1.2 injections. Metamorphopsia decreased in all patients and completely disappeared in fourteen eyes. Mean BCVA was 0.5±0.3 logMAR at M1 and 0.6±0.5 logMAR at M6 and M12. No adverse events related to the intravitreal injections were observed. CONCLUSION: Our study showed that IVB (Avastin(®)) is effective in the treatment of high myopic CNV. Moreover, only a small number of intravitreal injections were required to treat this condition.