Choroidal neovascularisation complicating geographic atrophy in age-related macular degeneration.

Abstract OBJECTIVE: To investigate the morphological and functional outcomes after intravitreal ranibizumab injections for choroidal neovascularisation (CNV) complicating geographic atrophy (GA). DESIGN: Retrospective, interventional, consecutive case series. METHODS: We reviewed the charts of all consecutive patients with GA due to age-related macular degeneration (AMD), who received intravitreal ranibizumab injections for the development of CNV at least 24 months earlier. RESULTS: 21 treatment-naive eyes of 21 consecutive patients (4 men, 17 women, mean age 86.9±1.6 years) were included. In 95.2% of eyes a type 2 CNV was present, extrafoveal in 42.8% of cases. After a mean of 5.0±0.87 (range 1-20) intravitreal ranibizumab injections, best-corrected visual acuity (BCVA) significantly worsened at the 24-month follow-up visit (0.73±0.05 vs 0.88±0.08 logMAR, respectively; p=0.01). A significant reduction of intraretinal cystic lesions, subretinal fluid and pigment epithelium detachment (p<0.001) and a significant increase of GA area (p=0.003) were present at last visit. CONCLUSIONS: Ranibizumab treatment of GA-associated CNVs provides no BCVA improvement at 24 months follow-up despite an anatomic response of CNV. Low effectiveness of ranibizumab in these cases is likely due to GA progression

Intrasession and Between-Visit Variability of Sector Peripapillary Angioflow Vessel Density Values Measured with the Angiovue Optical Coherence Tomograph in Different Retinal Layers in Ocular Hypertension and Glaucoma

PURPOSE: To evaluate intrasession and between-visit reproducibility of sector peripapillary angioflow vessel-density (PAFD, %) values in the optic nerve head (ONH) and radial peripapillary capillaries (RPC) layers, respectively, and to analyze the influence of the corresponding sector retinal nerve fiber layer thickness (RNFLT) on the results. METHODS: High quality images acquired with the Angiovue/RTVue-XR Avanti optical coherence tomograph (Optovue Inc., Fremont, USA) on 1 eye of 18 stable glaucoma and ocular hypertension patients were analyzed using the Optovue 2015.100.0.33 software version. Three images were acquired in one visit and 1 image 3 months later. RESULTS: PAFD image quality for all images necessary to calculate reproducibility was sufficient to analysis only in 18 of the 83 participants (21.7%) who were successfully imaged for RNFLT. Intrasession coefficient of variation (CV) ranged between 2.30 and 3.89%, and 3.51 and 5.12% for the peripapillary sectors in the ONH and RPC layers, respectively. The corresponding between-visit CV values ranged between 3.05 and 4.26%, and 4.99 and 6.90%, respectively. Intrasession SD did not correlate with the corresponding RNFLT in any sector in either layer (P>/=0.170). In the ONH layer sector PAFD values did not correlate with the corresponding RNFLT values (P>/=0.100). In contrast, in the RPC layer a significant positive correlation between the corresponding sector PAFD and RNFLT values was found for all but one peripapillary sectors (Pearson-r range: 0.652 to 0.771, P</=0.0046). CONCLUSION: Though in several patients routine use of PAFD measurement may be limited by suboptimal image quality, in the successfully imaged cases (21.7% of the study eyes in the current investigation) reproducibility of sector PAFD values seems to be sufficient for clinical research. In stable patients intrasession variability explains most of the between-visit variability. Sector PAFD variability is independent from sector RNFLT, a marker of glaucoma severity. In the RPC layer sector PAFD and RNFLT show strong to very strong positive correlation

Relationship between optical coherence tomography sector peripapillary angioflow-density and Octopus visual field cluster mean defect values

PURPOSE: To compare the relationship of Octopus perimeter cluster mean-defect (cluster MD) values with the spatially corresponding optical coherence tomography (OCT) sector peripapillary angioflow vessel-density (PAFD) and sector retinal nerve fiber layer thickness (RNFLT) values. METHODS: High quality PAFD and RNFLT images acquired on the same day with the Angiovue/RTVue-XR Avanti OCT (Optovue Inc., Fremont, USA) on 1 eye of 27 stable early-to-moderate glaucoma, 22 medically controlled ocular hypertensive and 13 healthy participants were analyzed. Octopus G2 normal visual field test was made within 3 months from the imaging. RESULTS: Total peripapillary PAFD and RNFLT showed similar strong positive correlation with global mean sensitivity (r-values: 0.6710 and 0.6088, P<0.0001), and similar (P = 0.9614) strong negative correlation (r-values: -0.4462 and -0.4412, P</=0.004) with global MD. Both inferotemporal and superotemporal sector PAFD were significantly (</=0.039) lower in glaucoma than in the other groups. No significant difference between the corresponding inferotemporal and superotemporal parameters was seen. The coefficient of determination (R2) calculated for the relationship between inferotemporal sector PAFD and superotemporal cluster MD (0.5141, P<0.0001) was significantly greater than that between inferotemporal sector RNFLT and superotemporal cluster MD (0.2546, P = 0.0001). The R2 values calculated for the relationships between superotemporal sector PAFD and RNFLT, and inferotemporal cluster MD were similar (0.3747 and 0.4037, respectively, P<0.0001). CONCLUSION: In the current population the relationship between inferotemporal sector PAFD and superotemporal cluster MD was strong. It was stronger than that between inferotemporal sector RNFLT and superotemporal cluster MD. Further investigations are necessary to clarify if our results are valid for other populations and can be usefully applied for glaucoma research

Editor's Choice – European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Radiation Safety

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Near-infrared reflectance imaging of neovascular age-related macular degeneration

Contains fulltext : 81007.pdf (publisher's version ) (Closed access)PURPOSE: To evaluate various types of neovascular age-related macular degeneration (AMD) by near-infrared fundus reflectance (NIR) as compared to fundus fluorescein angiography (FFA) and to test NIR for assessment of leakage due to choroidal neovascularization (CNV). PATIENTS AND METHODS: Thirty-three patients with neovascular AMD (cases) and 20 age-matched patients with non-exudative AMD and healthy subjects (controls) were examined with a confocal scanning laser ophthalmoscope (Heidelberg Retina Angiograph 2). NIR images of neovascular AMD were qualitatively compared to the corresponding FFA and to age-matched controls. CNV membranes and exudation areas were manually segmented on FFA and NIR and analyzed quantitatively. Results : Of all cases included, five eyes had classic CNV, six had minimal classic lesions, 15 occult CNV's and seven eyes had retinal angiomatous proliferation (RAP). A dark halo on NIR was found in all cases and showed high correspondence to leakage on FFA (r (2) = 0.93; p < 0,0005). In classic CNV and minimal classic CNV, the classic part of the lesion on FFA revealed strong correlation to a dark core surrounded by a bright reflecting ring on NIR (r (2) = 0.88; p < 0.0005). Occult parts on FFA of minimal classic CNV and occult CNV lesions appeared as poorly demarcated, jagged areas of increased NIR. RAP was characterized by speckled NIR located at the intraretinal neovascular complex. CONCLUSIONS: NIR imaging in neovascular AMD revealed characteristic alterations depending on the type of CNV. These changes may reflect histological differences of the lesions. Leakage caused local darkening of NIR, presumably originating from increased light-scattering and absorbance by fluid accumulation and sub-cellular structure alterations

Editor's Choice – European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease

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Impact of organised programs on colorectal cancer screening

<p>Abstract</p> <p>Purpose</p> <p>Colorectal cancer (CRC) screening has been shown to decrease CRC mortality. Organised mass screening programs are being implemented in France. Its perception in the general population and by general practitioners is not well known.</p> <p>Methods</p> <p>Two nationwide observational telephone surveys were conducted in early 2005. First among a representative sample of subjects living in France and aged between 50 and 74 years that covered both geographical departments with and without implemented screening services. Second among General Practionners (Gps). Descriptive and multiple logistic regression was carried out.</p> <p>Results</p> <p>Twenty-five percent of the persons(N = 1509) reported having undergone at least one CRC screening, 18% of the 600 interviewed GPs reported recommending a screening test for CRC systematically to their patients aged 50–74 years. The odds ratio (OR) of having undergone a screening test using FOBT was 3.91 (95% CI: 2.49–6.16) for those living in organised departments (referent group living in departments without organised screening), almost twice as high as impact educational level (OR = 2.03; 95% CI: 1.19–3.47).</p> <p>Conclusion</p> <p>CRC screening is improved in geographical departments where it is organised by health authorities. In France, an organised screening programs decrease inequalities for CRC screening.</p

Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study

Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March – May 2020, “period 1”), and then again between May and June (“period 2”) and June and July 2020 (“period 3”). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. Results: The impact of the pandemic continued to be felt well after countries’ first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. Conclusion: Centres reported a broad return of services approaching pre-pandemic “normal” by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries