Antiplatelet and anticoagulant agents in vitreoretinal surgery: a prospective multicenter study involving 804 patients

Letter to the Editor (by invitation)International audienc

Antiplatelet and anticoagulant agents in vitreoretinal surgery: a prospective multicenter study involving 804 patients [Letter to the Editor (by invitation)]

Letter to the Editor (by invitation).International audienc

Intravitreal ranibizumab for neovascular agerelated macular degeneration with a Treat and Extend protocol: anatomical and functional results

National audiencePurpose: To evaluate the efficacy of the Treat andExtend regimen using intravitreal ranibizumab for neovascular age-related macular degeneration (nAMD) Methods: A retrospective single-center study including naive nAMD patients confirmed with a fluorescein and indocyanine green angiography and a macular SD-OCT. After 3 monthly intravitreal ranibizumab injections, the interval between two injections was sequentially extended or shortened by 2 weeks depending on the presence or the absence of exudative disease with a maximum of 12 weeks. At each visit, an ETDRS VA and a macular SD-OCT were performed. The functional outcomes were the gain in VA and the proportion of patients gaining at least three lines. The anatomical outcome was central retinal thickness (CRT) on OCT. The secondary outcomes were the number of injections. Results: 111 patients were followed for one year, and 66 of them for two years. At baseline, the median VA was 59 [45-70] letters and the median CRT was 326 [271-402] µm. The median VA gain was 9 [2-17] letters after one year and 10 [2-23] letters after two years. Almost 30% gained more than three lines after 1 year and 42% after 2 years. The median decrease in CRT was 80 [29-161] µm and 100 [57-151] µm after 1 and 2 years, respectively. The median number of injections was 9 [8-10] after one year and 10 [2-23] after 2 years. Conclusion: A Tret and Extend regimen with ranibizumab provides good visual outcomes after 1 and 2 years of follow-up and seems to be an efficient strategy for the treatment of nAMD

Antiplatelet and anticoagulant agents in vitreoretinal surgery: a prospective multicenter study involving 804 patients

Publication for the CFSR Research NetInternational audiencePURPOSE: To assess the rate of hemorrhagic complications after vitreoretinal surgery and the influence of antithrombotic agents. METHODS: Hemorrhagic complications of vitreoretinal procedures performed in seven ophthalmologic centers on patients treated or not treated with antiplatelet (AP) or anticoagulant (AC) agents were prospectively collected. Patients' characteristics, surgical techniques, and complications were recorded during surgery and for 1 month after. RESULTS: Eight hundred four procedures were performed between January 2015 and April 2015. Among them, 18.4% were treated with AP agents (n = 148) and 7.8% with AC agents (n = 63), with 18 of them treated with NOACS (new oral anticoagulants). AP or AC agents were continued in 96.5% and 80.7% of cases, respectively. Fifty-three patients (6.6%) developed one or more hemorrhagic complications in one eye during this period. In univariate analysis, AC agents were not associated with hemorrhagic complications (P = 0.329) in contrast to AP (P = 0.005). However, in multivariate analysis, AP agents were no longer associated with hemorrhagic complications and the intraoperative use of endodiathermy was the only factor associated with hemorrhagic complications (P = 0.001). CONCLUSIONS: This study showed that AP and AC agents were not a factor associated with hemorrhagic complications during vitreoretinal surgery. The continuation of these treatments should be considered without risk of severe hemorrhagic complications

Bilateral acute macular neuroretinopathy in a young woman after the first dose of Oxford–AstraZeneca COVID-19 vaccine

International audienceTo report a case of bilateral acute macular neuroretinopathy following the first dose of Oxford-AstraZeneca COVID-19 (coronavirus disease 2019) vaccine in a young, Caucasian, and healthy woman. Observations: A 25-year-old Caucasian female patient presented to the ophthalmology department of Dijon University Hospital with a 3-week history of black spots and paracentral scotoma in both eyes. She had no past medical history and was using the combined estrogen-progestin oral contraceptive (COC). These symptoms occurred 24 h after receiving the first Oxford-AstraZeneca COVID-19 vaccination dose. The ophthalmologic signs were preceded a few hours earlier by fever and flu-like symptoms. Ophthalmologic examination revealed a preserved visual acuity with a quiet anterior segment and normal fundus in both eyes. Findings on multimodal retinal imaging, particularly near-infrared reflectance (NIR) and optical coherence tomography (OCT) imaging, were classical of an acute macular neuroretinopathy in both eyes. Conclusions and importance: COVID-19 vaccination is justified as an essential public health measure. Acute macular neuroretinopathy may occur in patient receiving a COVID-19 vaccination dose. Further reports are needed to confirm this association. Physicians should be aware of this complication and request an eye examination with at least OCT or NIR imaging in the case of any visual symptoms after vaccination, notably in young women using COC

Peripapillary microvascularization analysis using swept-source optical coherence tomography angiography in optic chiasmal compression

International audiencePurpose. To evaluate the vessel density (VD) of the radial peripapillary capillary (RPC) network using swept-source optical coherence tomography angiography (SS-OCTA) “en face” images of eyes with chiasmal compression caused by brain tumors before and after decompressive surgery compared with healthy controls. Methods. A cross-sectional study was conducted in 12 patients with chiasmal compression confirmed by neuroimaging. Sixteen healthy participants were also included. All patients with chiasmal compression underwent a neuro-ophthalmological examination one week before and 6 months after brain surgery, including static automated perimetry as well as measurement of the thickness of the retinal nerve fiber layer (RNFL) and the ganglion cell complex (GCC) with spectral-domain optical coherence tomography (SD-OCT). Based on this neuro-ophthalmological examination, the presence of an optic neuropathy (ON) was evaluated. Peripapillary VD was obtained in four sectors on a 6 × 6 mm SS-OCTA image using the Cirrus Plex Elite 9000. Results. Baseline average VD was significantly lower in patients with chiasmal compression and ON than in controls (median: 55.62; interquartile range (IQR): 2.96 vs. 58.53; IQR: 2.02; p = 0.003 ). This decrease was also found in the temporal, superior, and nasal sectors. Average postoperative VD was decreased in patients with chiasmal compression compared with average preoperative VD (median: 56.16; IQR: 4.07 vs. 57.48; IQR: 3.83; p = 0.004 ). Preoperative VD was significantly correlated with RNFL, GCC thickness, and visual field defects. Conclusions. The VD of the RPC network was decreased in chiasmal compressive ON, and it was further decreased at 6 months after decompressive surgery

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

Prevalence of dry eye disease in elderly individuals of the French population (the MONTRACHET Study)

Purpose To report the prevalence of dry eye in a large population-based sample of French individuals older than 75 years. Methods About 9000 individuals 65 years and older were included in the 3C cohort study since 1999 in 3 French cities (Bordeaux, Dijon and Montpellier). In Dijon, an additional ophthalmic examination was performed 10 years after the initial inclusions to assess the relation between systemic age-related diseases and eye diseases in the MONTRACHET Study (Maculopathy Optic Nerve nuTRition neurovAsCular and HEarT diseases). Dry eye symptoms were collected with self reported history of dry eye symptoms, use of topical medications and evaluated by the Ocular Surface Disease Index (OSDI) questionnaire. Every patient underwent ophthalmic evaluation which included Schirmer I test without anesthesia, tear film break up time measurement and fluorescein cornea1 staining evaluation. Prevalence of dry eye was evaluated with subjective criteria (history and OSDI questionnaire) and objective criteria. Results One thousand and twenty four subjects were included in the study. Mean age was 83.7 ± 3.8 years old. 62.9% of the patients were women (644). Prevalence of dry eye is reported in Tables 1 and 2. (Δ : Variable; BUT : Break-Up-Time; Fluo : Fluorescein staining; - : Négative; + : Positive) Conclusions As reported in the literature, this study shows wide variations in dry eye prevalence depending on the sign or symptoms considered

Cystoid Macular Edema after Rhegmatogenous Retinal Detachment Repair with Pars Plana Vitrectomy: Rate, Risk Factors, and Outcomes

International audience(1) Background: The aim was to describe the rate and outcomes of cystoid macular edema (CME) after pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) and to identify risk factors and imaging characteristics. (2) Methods: A retrospective consecutive case study was conducted over a 5-year period among adult patients who underwent PPV for primary RRD repair. The main outcome measure was the rate of CME at 12 months following PPV. (3) Results: Overall, 493 eyes were included. The CME rate was 28% (93 patients) at 12 months. In multivariate analysis, eyes with worse presenting visual acuity (VA) (odds ratio [OR], 1.55; 95% CI, 1.07–2.25; p = 0.02) and grade C proliferative vitreoretinopathy (PVR) (OR, 2.88; 95% CI, 1.04–8.16; p = 0.04) were more at risk of developing CME 1 year after PPV. Endolaser retinopexy was associated with a greater risk of CME than cryotherapy retinopexy (OR, 3.06; 95% CI, 1.33–7.84; p = 0.01). Eyes undergoing cataract surgery within 6 months of the initial RRD repair were more likely to develop CME at 12 months (OR, 1.96; 95% CI, 1.06–3.63; p = 0.03). (4) Conclusions: CME is a common complication after PPV for primary RRD repair. Eyes with worse presenting VA, severe PVR at initial presentation, endolaser retinopexy, and cataract surgery within 6 months of initial RRD repair were risk factors for postoperative CME at 12 months