What is driving the decision to perform filtering surgery in glaucoma patients?

Purpose: To assess what is driving the decision to perform a filtering procedure in glaucoma patients. Methods: Retrospective study in one single University center. All the indications for filtering glaucoma surgeries (alone or combined with cataract extraction) performed in 2013 by the same surgeon were reviewed. The indications were as follows: clinical evaluation of the optic disc, visual field progression, progression on imaging (OCT), poor tolerance to medical treatment, poor control of intraocular pressure (IOP) and cataract. Results: The filtering surgeries (n = 159) were as follows: 78 trabeculectomies, 45 combined cataract and deep sclerectomy, 24 combined cataract and trabeculectomy, 9 deep sclerectomies and 3 tubes. The types of glaucoma were as follows: primary open-angle glaucoma (76%), secondary glaucoma (14%) and angle closure glaucoma (10%). Poor control of IOP was the first indication (51%) followed by cataract (13%), clinical evaluation of the optic disc (12%), visual field progression (12%), poor tolerance to medical treatment (11%) and progression on imaging (1%). Conclusions: In this series, the yield of imaging seems very poor to help the decision to perform a filtering procedure in glaucoma patients. The indications for glaucoma surgery may be highly variable according to the country, the practice and the surgeon. A multicenter study should be useful to better define what is driving the indications for glaucoma surgery

Long-Term Anatomical and Functional Outcomes after Combined Cataract and Idiopathic Epiretinal Membrane Surgery

Free Supplementary Material: https://dx.doi.org/10.6084/m9.figshare.4483442International audiencePurpose: To describe the 2-year functional and anatomical outcomes in patients operated on for combined cataract and idiopathic epiretinal membrane (ERM) and to study the relationship between best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SDOCT) throughout the follow-up. Methods: This retrospective observational case series included 72 eyes operated on for combined cataract and idiopathic ERM. They were followed with clinical and SD-OCT examinations preoperatively and 1, 6, 12, and 24 months after surgery. Foveolar thickness (FT), photoreceptor status and morphological parameters were assessed. Results: BCVA and FT substantially improved at 24 months. Postoperatively, no significant improvement was observed beyond 6 months for BCVA and 12 months for FT. Outer limiting membrane and inner and outer segment junction disruption scores were well correlated with BCVA both pre-and postoperatively, and significant visual improvement was demonstrated in each subgroup except inthose with the highest scores. FT was correlated with BCVA only from 6 to 24 months postoperatively. Conclusion: After combined cataract and idiopathic ERM surgery, BCVA and FT improved rapidly. Most functional and anatomical recovery took place within the first 6 months, but this did not preclude late improvement, in particular in patients with the most disorganized photoreceptor layers. At each time point, the amount of photoreceptor damage seemed closely correlated with visual acuity, but concerning FT, this relationship remains questionable

Diagnostic ability of spectral‐domain optical coherence tomography peripapillary retinal nerve fiber layer thickness to discriminate glaucoma patients from controls in an elderly population (The MONTRACHET study)

International audiencePurpose To evaluate the capacity of retinal nerve fibre layer (RNFL) thickness measured by SD-OCT to discriminate glaucoma patients from controls in an elderly population. Methods The MONTRACHET (Maculopathy, Optic Nerve, nuTRition, neurovAsCular and HEarT diseases) Study is a population-based study including participants aged 75 years and over. All participants underwent a complete eye examination with optic nerve photographs, visual field testing and OCT peripapillary RNFL thickness measurement. Glaucoma was defined according to the ISGEO (International Society for Epidemiologic and Geographical Ophthalmology) classification. Performance indicators were calculated including area under the receiver operating characteristics curves (AUC), likelihood ratios (LR) and diagnostic odds ratios (DOR). Results In total, 1061 participants were included in the study, of whom 89 were classified as having glaucoma and 972 were classified as normal. The mean (SD) age of the population was 82.3 (3.7) years. The average RNFL thickness was significantly lower in the glaucoma group than in controls 64.0 (14.9) mu m versus 88.9 (12.4) mu m, respectively, p < 0.001) and in all sectors compared with controls. The average RNFL thickness had the highest AUC (0.901) followed by the temporal-inferior (0.879) and temporal-superior sectors (0.862). When RNFL thickness was classified as abnormal by SD-OCT, the average RNFL thickness had the best sensitivity (83.75%) followed by the temporal-inferior sector (75.64%). The specificity for these two parameters was 87.34% and 91.08%, respectively. The highest DOR was 28.70 for average RNFL thickness and reached 34.84 when using the reference database of the OCT manufacturer. Conclusion This study confirms that SD-OCT could be useful as an additional test to discriminate glaucoma patients from controls in an elderly population

Retinopathy of prematurity screening: evaluation of a first screening

Purpose: Retinopathy of prematurity (ROP) screening concerns preterm infants born before 32 weeks of amenorrhea and/or weighting less than 1500 grams. First screening occurs usually 4 to 6 weeks after birth and always after 31 weeks of amenorrhea. The purpose of this study was to investigate the number of examinations performed before the first signs of retinopathy, in order to determine the best time for first screening.Methods: This retrospective study enrolled preterm infants born before 32 weeks of amenorrhea and/or weighting less than 1500 grams in the University Hospital of Dijon, France, between 11/15/2012 and 12/31/2013. All preterm babies benefited from a ROP screening by fundus photography with a wide field camera. First screening was realized 4 to 6 weeks after birth and after 31 weeks of amenorrhea. All photographs were analysed. Population characteristics, number of examinations before first signs of retinopathy, term at first examination, at first signs of retinopathy and at the most severe signs of retinopathy were noted.Results: Hundred and eight preterm infants were enrolled; 33 were affected by ROP. Median [IQR] term was 29.6 [27.0 ; 31.0] weeks of amenorrhea. Median weight was 1118 [915 ; 1431] grams. Median number of examinations in preterm infants with ROP was 7 [4 ; 9]. Median term at first screening, at first signs of retinopathy and at more severe signs of retinopathy were 31.7 [30.9 ; 32.1], 33.7 [32.3 ; 35.0], 36.9 [35.6 ; 37.9] weeks of amenorrhea, respectively. Median number of examinations before first signs of retinopathy was 1 [1 ; 2]. In 25 preterm infants weighting less than 1000 grams, median term at first signs of retinopathy was 33.3 [32.3 ; 34.6], versus 34.8 [34.3 ; 35.2] in 8 preterm infants weighting more than 1000 grams (p=0.03).Conclusions: In ROP, the time of first screening is not well defined. According to our series, a first screening at 33 weeks of amenorrhea seems optimal

Incidence de l’endophtalmie aiguë postopératoire après chirurgie de la cataracte par phacoémulsification et injection intracamérulaire d’antibiotiques, en France de 2005 à 2014

National audienceIntroduction La chirurgie de la cataracte est l’intervention la plus fréquente dans le monde. Parmi ses complications, l’endophtalmie aiguë postopératoire (EAPO) est une infection intraoculaire sévère, qui peut conduire à la cécité. Les objectifs étaient de déterminer l’incidence de l’EAPO après chirurgie de la cataracte par phacoémulsification en France de 2005 à 2014 et d’analyser l’association entre injection intracamérulaire d’antibiotique (IICA) et EAPO. Méthodes Tous les patients hospitalisés pour une chirurgie de la cataracte en France entre le 1er janvier 2005 et le 31 décembre 2014 ont été identifiés dans le programme de médicalisation des systèmes d’information (PMSI). L’EAPO était définie par la présence d’un diagnostic d’endophtalmie lors d’une hospitalisation survenant dans les 42jours postopératoire. L’IICA était définie par la présence d’un acte d’IICA lors de la chirurgie de la cataracte. L’association entre EAPO et IICA a été estimée par des ratios de taux d’incidence (IRR) calculés à l’aide de régressions de Poisson. Résultats De 2005 à 2014, 6 371 242 actes de chirurgie de la cataracte par phacoémulsification ont eu lieu chez 3 983 525 patients. L’incidence de l’EAPO a diminué, passant de 0,145 à 0,053 pour 100 interventions par an. En analyse multivariée, l’IICA était associée à un risque plus faible d’EAPO (IRR=0,53 ; IC 95 % [IC 95]=[0,50-0,57] ; p<0,001). Le risque d’EAPO était plus élevé avec la survenue d’une rupture peropératoire de la capsule postérieure (IRR=5,24 ; IC 95=[4,11-6,68] ; p<0,001), la chirurgie combinée (IRR=1,77 ; IC 95=[1,53-2,05] ; p<0,001) et le sexe masculin (IRR=1,48 ; IC 95=[1,40-1,56] ; p<0,001). Discussion/Conclusion Le PMSI nous a permis d’observer une diminution de l’EAPO après chirurgie de la cataracte par phacoémulsification entre 2005 et 2014. Dans la même période, l’IICA durant les procédures chirurgicales a fortement augmenté et était associée à un risque moins élevé d’EAPO

Incidence of acute postoperative endophthalmitis after cataract surgery a nationwide study in France from 2005 to 2014

PURPOSE:To report the incidence of acute postoperative endophthalmitis (POE) after cataract surgery from 2005 to 2014 in France.DESIGN:Cohort study.PARTICIPANTS:Patients undergoing operation for cataract surgery by phacoemulsification and presenting acute POE.METHODS:We identified acute POE occurring within 6 weeks after phacoemulsification cataract surgery and the use of intracameral antibiotic injection during the surgical procedure by means of billing codes from a national database.MAIN OUTCOME MEASURES:Incidence of acute POE.RESULTS:From January 2005 to December 2014, 6 371 242 eyes in 3 983 525 patients underwent phacoemulsification cataract surgery. The incidence of acute POE after phacoemulsification decreased from 0.145% to 0.053% during this 10-year period; the unadjusted incidence rate ratio (IRR) (95% confidence interval) was 0.37 (0.32-0.42; P < 0.001). In multivariate analysis, intracameral antibiotic injection was associated with a lower risk of acute POE 0.53 (0.50-0.57; P < 0.001), whereas intraoperative posterior capsule rupture, combined surgery, and gender (male) were associated with a higher risk of acute POE: 5.24 (4.11-6.68), 1.77 (1.53-2.05), and 1.48 (1.40-1.56) (P < 0.001), respectively.CONCLUSIONS:Access to a national database allowed us to observe a decrease in acute POE after phacoemulsification cataract surgery from 2005 to 2014. Within the same period, the use of intracameral antibiotics during the surgical procedures increased

Preoperative prognostic factors and predictive score in patients operated on for combined cataract and idiopathic epiretinal membrane

PURPOSE: To report preoperative prognostic factors associated with visual acuity recovery 1 year after combined cataract and idiopathic epiretinal membrane (ERM) surgery and to introduce a predictive score. DESIGN: Interventional case series and estimation of a predictive score. METHODS: One hundred forty-two patients (1 eye per patient) operated on for combined cataract and idiopathic ERM in the University Hospital of Dijon were followed for 12 months. Preoperative clinical features and spectral-domain,optical coherence tomography (OCT) parameters were compared between eyes that recovered >= 20/20 final best-corrected visual acuity (BCVA) and those with = 20/20 BCVA and 82 (58%) had lower visual results. Logistic regression analysis showed that final BCVA was associated with age (P = .040), duration of symptoms (P = .025), initial BCVA (P = .002), and inner and outer segment (IS/OS) junction disruption on spectral-domain OCT (P = .010). The preoperative 10-point predictive score including these parameters reached 82% sensitivity and 66% specificity. With a score >5, patients had a >= 56% chance of recovering 20/20 final BCVA instead of <= 27% when the score was <= 5. CONCLUSIONS: Age, duration of symptoms, and initial BCVA appear to be reliable prognostic factors in patients undergoing combined cataract and idiopathic ERM surgery. Combining these factors with analysis of the IS/OS junction provides a predictive score to estimate individual chances of good visual outcome

Prevalence of age-related macular diseases in an old French population (the MONTRACHET Study)

National audiencePurpose To describe the prevalence of age‐related macular diseases in a French population‐based study (the Montrachet study) older than 74 years. Methods The Three City study (3C) was a prospective study including 9294 patients aged of 65 years or more from three French cities (Dijon, Bordeaux, and Montpellier) at enrolment in 1999. After 10 years of follow‐up, an eye examination was proposed to participants of the 3C cohort in Dijon and 1153 participants were included in the so‐called Montrachet study. All patients underwent a complete eye examination including nonmydriatic color retinal photographs. The photographs were classified according to the type of abnormality (intermediate soft drusen, large soft distinct or indistinct drusen, reticular drusen or large area of soft drusen reaching 500 µm in diameter, hyperpigmentation or hypopigmentation), and their location (central or pericentral) using the classification of the Multi‐ethnic Study of Atherosclerosis (MESA) and that used in the Rotterdam Study. Patients were then classified into 3 categories: early age‐related macular degeneration (AMD), late AMD (atrophic or neovascular). Results Data were available for 1069 patients: 396 men (37.0%) and 673 women (63.0%). The mean age was 82.2 ± 3.8 years. The prevalence of healthy subjects was 56.0%. Stages 1, 2 and 3 accounted for 32.6%, 7.7% and 1.5%, respectively. The late AMD stages represented 2.2% (24 patients). Smoking was not significantly associated with AMD categories. Conclusions The prevalence of AMD grading in our population is consistent with the literature. The classification of participants according to different macular abnormalities may predict the populations at risk of developing an advanced grade and can help to adapt the management. The relationship with other risk factors will be the next step of this analysis

Subretinal drusenoid deposits in an elderly population with age-related macular degeneration (MONTRACHET study: Maculopathy, Optic Nerve, nuTRition, neurovasCular and HEarT diseases)

National audiencePurpose To determine the frequency of subretinal drusenoid deposits (SDD) in a French population of elderly patients presenting an age‐related macular degeneration (AMD) in the MONTRACHET study. Methods The three‐city study (3C) was a population‐based study including 9294 patients older than 65 years from three French cities (Dijon, Bordeaux and Montpellier) at baseline in 1999. After 10 years, the cohort of Dijon benefited from a complete ophthalmologic examination as part of the MONTRACHET study. Each patient underwent a non‐mydriatic retinophotography associated with a spectral‐domain OCT examination (SD‐OCT) of the macula. AMD classification was established according to the classification of the Multi‐Ethnic study of Atherosclerosis (MESA) for the retinophotography analysis and with the E3 CONSORTIUM classification for the SD‐OCT analysis. Patients with uninterpretable images of both eyes were excluded from statistical analysis. Results One thousand one hundred fifty three subjects were included. 62.7% were female and the mean age was 82.2 ± 3.8 years. With retinophotography analysis, the frequency of SDD was 1.9% (n = 38 eyes). With the SD‐OCT macular analysis, the frequency of SDD was 14.8% (n = 342). In patients presenting with SDD, 68.8% (n = 137) had a bilateral involvement. The relative risk (RR) of presenting SDD lesions in patients older than 80 years old was 2.6 (p < 0.001) and in women at 1.3 (p < 0.045). An interruption of the ellipsoide line and an alteration of the retinal pigment epithelium were statistically associated with the presence of SDD: RR = 5.9 (p < 0.001) and RR = 2.8 (p < 0.001), respectively. The average thickness of the subfoveal choroid was thinner in subjects presenting SDD (174.9 μm with SDD vs 209.8 μm without SDD, p < 0.001). Conclusions Few population‐based studies have established the frequency of SDD in an elderly population