Functional and anatomical outcomes after successful macula-off retinal detachment surgery, a 12 month-follow-up

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Spasme du dilatateur pupillaire ou pupille en têtard

Spasme du dilatateur pupillaire ou pupille en têtar

Safety and long-term efficacy of repeated dexamethasone intravitreal implants for the treatment of cystoid macular edema secondary to retinal vein occlusion with or without a switch to anti-VEGF agents: a 3-year experience

Article de 8 p.International audiencePURPOSE: To evaluate the safety and efficacy of repeated dexamethasone intravitreal implants (DEX implants) over 3 years in eyes with macular edema (ME) secondary to branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO). METHODS: We conducted a 3-year, retrospective, multicenter study that included adult patients with ME secondary to BRVO or CRVO treated with first-line DEX implants. Patients were divided into two different subgroups: patients who received DEX implant injections only (group 1) and those who received DEX implants first and then were switched to anti-VEGF agents (group 2). Primary endpoints were changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) from baseline to month 6 and month 36. Secondary endpoints included changes in both BCVA and CRT after each DEX implant and adverse events, particularly cataract extraction and elevated intraocular pressure (IOP). RESULTS: Sixty-six patients with a median [IQR (interquartile ratio)] age of 72 [65.0; 81.1] years were included (40.9% BRVO, 59.1% CRVO), who received a median of 5.0 [min, 1.0; max, 10.0] DEX implants over 3 years. Median [IQR] time to retreatment was 4.8 [4.2; 6.0] months. The median [IQR] improvements in BCVA from baseline until months 6 and 36 were respectively + 10.0 [0; + 20.0] letters (P = 0.040) and + 10.0 [- 8.7; + 20.0] letters (P = 0.364) in the whole population. In group 1, the results were similar, whereas in group 2, BCVA significantly increased at M36 compared with baseline (P = 0.003). The median [IQR] CRT reductions from baseline to months 6 and 36 were respectively - 227.5 [- 337.0; - 52.7] mum and - 224.0 [- 405.0; - 83.8] mum (P < 0.001) in the whole population. Results were similar in both groups. The most common adverse events were cataract extraction (70.4%) and elevated IOP (54.5%). No other serious local complications were observed. Treatment was switched to anti-VEGF agents in 16 (24.2%) patients. CONCLUSIONS: DEX implants are an effective treatment for BRVO and CRVO-associated ME over 3 years. It is a valid treatment even though complications remain frequent. However, functional efficacy seems to decrease with time and repeated injections

Vitreomacular interface abnormalities and glaucoma in an elderly population (the MONTRACHET study)

International audiencePurpose: To investigate the prevalence of vitreomacular interface abnormalities (VMIAs) in a French elderly glaucomatous population. Methods: Using a population-based study, the MONTRACHET (Maculopathy Optic Nerve nuTRition neurovAsCular and HEarT diseases) study conducted in Dijon from 2009 to 2013 in individuals older than 75 years, the prevalence of VMIAs was estimated on glaucoma patients. Results: A total of 1130 participants (2225 eyes) were included in the study. The mean age of participants was 82.3 +/- 3.8 years, and 62.74% were women. Regarding the frequency of all VMIAs, there was no statistical difference between glaucoma patients and nonglaucoma participants (51.85% vs. 53.92%, respectively, P = 0.372). In univariate analysis, vitreomacular adherences were more frequent in nonglaucoma participants (18.39% vs. 10.78%, P = 0.036). Epiretinal membranes were more frequent in the glaucomatous population (47.06% vs. 38.13%, P = 0.018). The prevalence of macular cysts was comparable in the two groups (7.84% vs. 5.64%, P = 0.262). Macular cysts were more frequent in eyes treated with preservative-free, IOP-lowering eye drops when compared with the eyes of nonglaucomatous participants treated with IOP-lowering eye drops containing a preservative (26.67% vs. 3.37% and 5.76%, respectively, P < 0.001). In multivariate analysis, these results were no longer significant. Conclusions: The prevalence of VMIAs was high in this elderly population and similar in both glaucomatous and nonglaucomatous participants. The information provided by macular optical coherence tomography scans should be considered with caution when used for glaucoma management in elderly patients

Recours à la biothérapie dans la prise en charge de la maladie de Behçet dans un service de médecine interne

National audienceBACKGROUND: Behcet's disease (BD) is a recurrent multisystemic disease responsible for occlusive vasculitis with arterial, venous and capillary involvement. The aim of this study was to determine the frequency and the features associated with the use of biotherapy in the management of patients followed in our department for BD. METHODS: This is a retrospective study of patients medical records followed for BD in a department of internal medicine from January 2005 to August 2018. RESULTS: A total of 41 patients were included with a mean age at diagnosis of 42.5+/-12.1 years (range 16 to 63) and a sex ratio men/women of 1.05. Oral and/or genital aphtosis was present in 70.7% of the patients. Other lesions were: ocular (78.0%), articular (46.3%), cutaneous (41.5%), central neurological (34.1%), vascular (26.8%), digestive (7.3%), pericardial (2.4%) and epididymal (2.4%). A biotherapy, interferon alpha and monoclonal antibodies, was used in 15 patients (36.6%), after failure of conventional treatments. The monoclonal antibodies were anti-TNFalpha (infliximab, adalimumab, certolizumab and golimumab) except in one patient for whom ustekinumab was used. Biotherapy was used in 46.9% of the patients with ocular involvement and never used in those patients without ocular involvement (P=0.01). CONCLUSION: Biotherapy is effective and represents a solution to the failures of conventional treatments in severe forms of Behcet's disease with ocular involvement.Introduction : La maladie de Behçet (MB) est une vascularite occlusive artérielle, veineuse et capillaire responsable d’atteintes multisystémiques. L’objectif de cette étude était de déterminer la fréquence et les facteurs favorisants du recours à la biothérapie dans de la prise en charge des patients suivis dans notre service pour une MB. Méthodes : Il s’agit d’une étude rétrospective des dossiers des patients suivis pour une MB dans un service de médecine interne de janvier 2005 à août 2018. Résultats : Un total de 41 patients a été inclus avec un âge moyen au diagnostic de 42,5 ± 12,1 ans (extrêmes de 16 ans et 63 ans) et un sex-ratio hommes/femmes égal à 1,05. L’aphtose buccale et/ou génitale était présente chez 70,7 % des patients. Les autres atteintes répertoriées étaient : oculaires (78,0 %), articulaires (46,3 %), cutanées (41,5 %), neurologiques centrales (34,1 %), vasculaires (26,8 %), digestives (7,3 %), péricardique (2,4 %) et épididymaire (2,4 %). Une biothérapie, interféron α et anticorps monoclonaux, a été utilisée chez 15 patients (36,6 %), après échec des traitements conventionnels. Les anticorps monoclonaux utilisés étaient des anti-TNFα (infliximab, adalimumab, certolizumab et golimumab) sauf chez un patient où l’ustekinumab avait été utilisé. Le recours à la biothérapie était effectué dans 46,9 % des cas ayant une atteinte oculaire et chez aucun des patient sans atteinte oculaire (p = 0,01). Conclusion : Les biothérapies représentent une solution aux échecs des traitements conventionnels dans les atteintes oculaires de la MB en particulier

Potential of pegylated interferon alpha-2a in behcet uveitis: a report of five cases

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La choroïdite multifocale : présentation inaugurale d’une maladie des griffes du chat

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Œil et maladie des griffes du chat : 6 patients atypiques

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Intérêt de l’interféron pégylé alpha 2a dans le traitement des uvéites de la maladie de Behçet : à propos de 5 patients

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