CENTRAL SEROUS CHORIORETINOPATHY High-Resolution Imaging of Asymptomatic Fellow Eyes Using Adaptive Optics Scanning Laser Ophthalmoscopy

International audiencePurpose: To investigate cone density in the asymptomatic fellow eye of patients with unilateral central serous chorioretinopathy (CSCR). Methods: Seventeen asymptomatic fellow eyes of patients with unilateral CSCR and 17 eyes of aged-matched and gender-matched healthy controls underwent adaptive optics ophthalmoscopy. Cone density and spacing were assessed at the fovea. Clinical and multimodal imaging findings were also recorded. Results: In the CSCR group, the patient mean age was 48.9 ± 9.8 years. The mean (±SD) subfoveal choroidal thickness was 417.8 ± 125.2 mm. The foveal external limiting membrane and ellipsoid zone were intact in all patients. Adaptive optics fundus imaging showed a significant decrease in cone density at 2°of eccentricity nasal and temporal to the fovea in asymptomatic fellow eyes of patients with unilateral CSCR compared with controls (P = 0.001 and P = 0.027, respectively). No statistically significant difference in cone density was found at 4°of eccentricity nasal and temporal to the fovea between both groups. Conclusion: Asymptomatic fellow eyes of patients with unilateral CSCR showed a reduced density of foveal cones in the absence of a decreased visual acuity and photoreceptor line disruption on optical coherence tomography. These results suggest that the photoreceptors could be damaged independently of the occurrence of a serous retinal detachment

Evaluation d'un antagoniste du récepteur mineralocorticoide, l'eplerenone, dans le traitement de la chorioretinopathie sereuse centrale non resolutive à 3 mois. (Etude pilote sur 13 patients)

Objectifs. Cette étude pilote a pour but d'évaluer l'efficacité et la tolérance d'un antagoniste du récepteur minéralocorticoïde: l' éplérénone dans le traitement des choriorétinopathies séreuses centrales (CRSC) évoluant depuis plus de trois mois. Méthodes. Treize patients atteints de CRSC sans résolution spontanée à trois mois ont été inclus. Dix patients ont été traités par 50 mg/jour d'éplérénone pendant 3 mois et 3 patients pendant 1 mois. Ils étaient évalués à l'inclusion, à 1 mois et à 3 mois avec une mesure la meilleure acuité visuelle corrigée convertie en échelle logarithmique (logMAR) ainsi qu,'une mesure de l'épaisseur maculaire centrale et de la hauteur du décollement séreux rétinien évaluée en OCT (tomographie à cohérence optique). Un ionogramme sanguin avec une mesure de la kaliémie et de la clairance de la créatinine était réalisé à l'inclusion, 8 jours après le début du traitement puis tous les mois. Résultats. L'acuité visuelle initiale moyenne de 0,51+/- 0,24 s'est améliorée à 3 mois à 0,27 + /-0,19 en moyenne (p<O.OI) ; 90% des patients ont eu une amélioration de l'acuité visuelle d'une ligne ou plus. L'épaisseur maculaire centrale moyenne évaluée à 352 m+ /-139 à l'inclusi n a diminué de façon statistiquement significative à 182 m+ /-91 (p<O.OI) ; 67% des patients ont eu une résolution complète de leur décollement séreux rétinien après 3 mois de traitement. Aucun effet secondaire n'a été retrouvé. Conclusions. Les résultats de cette première étude tentant d'évaluer l'efficacité et la tolérance de l'éplérénone dans e traitement des CRSC non résolutives à 3 mois sont prometteurs. Ils devront être confirmés par une étude randomisée contrôlée.MONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Cystoid macular edema as a complication of central retinal artery occlusion

Purpose: To describe the development of cystoid macular edema (CME) as a complication of central retinal artery occlusion (CRAO) in 2 cases. Observations: The first patient was a 51-year-old female who presented with acute loss of vision in the left eye. Multimodal retinal imaging revealed a CRAO with a perfused cilioretinal artery. CME acutely developed one week after presentation. Cystoid spaces predominantly involved the outer nuclear layer (ONL) on optical coherence tomography (OCT) and completely resolved in two weeks. The second case was a 50-year-old man who presented with acute vision loss in the right eye for 3 weeks. Multimodal retinal imaging illustrated an acute CRAO of the right eye. Four weeks later, visual acuity spontaneously improved to 20/20 and was maintained at 20/20 for more than 2 years. After 28 months, the patient returned with a recurrent drop of vision in the right eye. Cross sectional and en face OCT revealed CME in the right eye without leakage on FA. Cystoid spaces predominantly involved the inner nuclear layer (INL) and resolved with intravitreal anti-VEGF injection combined with carbonic anhydrase inhibitor (CAI) and steroid topical drop therapy. Conclusions and Importance: CME can rarely complicate both the acute and chronic phase of CRAO. In the acute phase, cystoid spaces were transient and confined to the ONL on OCT. While in the chronic phase, cystoid spaces were confined to the INL on OCT and angiographically silent on FA. Further studies are needed to identify the incidence, underlying pathophysiology and visual prognosis of CME in cases of CRAO

Birdshot Chorioretinopathy: A Review

Birdshot chorioretinopathy (BSCR) is a bilateral chronic inflammation of the eye with no extraocular manifestations. BSCR affects middle-aged individuals from European descent and is strongly associated with the human leucocyte antigen (HLA)-A29 allele. The immune mechanisms involved are not fully understood, but recent advances have shown the role of Endoplasmic Reticulum Aminopeptidase 2 (ERAP2) in disease pathogenesis. Multimodal imaging, including fluorescein angiography, indocyanine angiography, fundus autofluorescence, and optical coherence tomography, are useful in confirming the diagnosis and monitoring disease activity. Visual field testing is also important to assess the disease progression. To date, there is no consensus for optimal treatment regimen and duration. Local and systemic corticosteroids can be used for short periods, but immunosuppressive or biological therapies are usually needed for the long-term management of the disease. Here, we will review publications focused on birdshot chorioretinopathy to give an update on the pathophysiology, the multimodal imaging, and the treatment of the disease

Mid-Phase Hyperfluorescent Plaques Seen on Indocyanine Green Angiography in Patients with Central Serous Chorioretinopathy

International audienceIndocyanine green angiography (ICG-A) shows the presence of mid-phase hyperfluorescent area in central serous chorioretinopathy (CSCR). However, their exact meaning remains uncertain. (2) The clinical and multimodal imaging findings of 100 patients (133 eyes) with CSCR, including the enhanced-depth-imaging OCT (EDI-OCT), blue-light fundus autofluorescence (BAF), fluorescein and indocyanine green angiography (FA and ICG-A) findings were reviewed. Mid-phase hyperfluorescent plaques (MPHP) were defined as fairly well circumscribed hyperfluorescent regions during the midphase of the ICG-A. The association between MPHP and other clinical/imaging parameters was assessed using a multiple logistic regression analysis. (3) MPHP were detected in 59.4% of eyes with CSCR. The chronic form of the disease, the presence of irregular pigment epithelium detachments (PED) and the retinal pigment epithelium (RPE) changes seen on FA were associated with the presence of MPHP in the multivariate analysis (p = 0.015; p = 0.018 and p = 0.002; respectively). OCT showed RPE bulges or PED in 98.7% of areas with MPHP and BAF showed changes in 57.3% of areas with MPHP. (4) MPHP were associated with a chronic form of CSCR and colocated with PED or RPE bulges. MPHP should be recognized as a sign of early RPE dysfunction before it is detected with BAF

Do litter-mediated plant-soil feedbacks influence Mediterranean oak regeneration? A two-year pot experiment

International audienceBackground & Aims: Oak seedling establishment is difficult and may be partly explained by littermediated interactions with neighbors. Litter effects can be physical or chemical and result in positive or negative feedback effects for seedlings. Mediterranean species leaves contain high levels of secondary metabolites which suggest that negative litter effects could be important.Methods: Seedlings of Quercus ilex and Quercus pubescens were grown for two years in pots with natural soil and litter inputs from 6 Mediterranean woody species, artificial litter (only physical effect) or bare soil.Results: Litter types had highly different mass loss (41-80%), which correlated with soil organic C, total N and microbial activity. Litter of Q. pubescens increased soil humidity and oak seedlings aerial biomass. Litters of Cotinus coggygria and Rosmarinus officinalis, containing high quantities of phenolics and terpenes respectively, decomposed fast and led to specific soil microbial catabolic profiles but did not influence oak seedling growth, chemistry or mycorrhization ratesConclusions: Physical litter effects through improved soil humidity seem to be predominant for oak seedling development. Despite high litter phenolics content, we detected no chemical effects on oak seedlings. Litter traits conferring a higher ability to retain soil moisture in dry periods deserve further attention as they may be critical to explain plant-soil feedbacks in Mediterranean ecosystems