Search

Resume Introduction La retinochoroidite toxoplasmique (RCT) est la premiere cause d’inflammation oculaire et d’uveite posterieure chez le patient immunocompetent. Plusieurs etudes ont montre l’efficacite et la surete d’un traitement des RCT par injection intravitreenne de clindamycine chez des patients presentant des contre-indications, des effets secondaires ou une mauvaise reponse au traitement oral. Le but de cette etude est de decrire les resultats anatomiques et fonctionnels d’un traitement local de RCT par IVT de clindamycine. Materiel et methode Nous avons mene une etude observationnelle, retrospective, unicentrique au CHU de Bordeaux, dans le service d’ophtalmologie entre decembre 2017 et janvier 2020 afin d’examiner la prise en charge de retinochoroidites toxoplasmiques par injection intravitreenne de clindamycine. Nous analysions l’efficacite du traitement sur l’amelioration de l’acuite visuelle, la diminution de la taille du foyer et la diminution de l’epaisseur maculaire. Resultats Un total de 10 yeux de 9 patients ont ete injectes. Une seule IVT a ete necessaire dans 9 cas sur 10. Les injections ont montre une amelioration des 3 criteres de jugement ; l’acuite visuelle est passee en moyenne de 1 LogMAR (1,07 ± 0,77) pre-injection a 0,4 LogMAR (0,43 ± 0,53)a 6 mois, la taille du foyer a diminuee de 51 % et l’epaisseur maculaire a diminuee de 78 μm en moyenne au cours du suivi. Conclusion Les IVT de clindamycine se sont montrees sures et efficaces dans le traitement des RCT. Elles presentent une alternative chez des patients allergiques, intolerants ou presentant une resistance au traitement oral.

Choosing a first-line treatment to optimize long-term outcomes is a major challenge for treating patients with neovascular age-related macular degeneration (AMD). The development of several new molecules makes it critical to identify the relevant factors to consider so as to provide an optimal risk-benefit ratio when initiating a treatment in naïve patients with neovascular AMD. This paper proposes a consensus established with the Delphi method (which includes a gradation in a consensus based on an analysis of the convergence rate of answers) to provide criteria that guide the ophthalmologist's decision for treatment initiation and follow-up in neovascular AMD patients. Fourteen questions were submitted to 93 French retina experts. Thirteen (93%) of the questions reached a consensus (≥50% of answers consensual). The criteria recommended to take into account were both efficacy and onset of action of the molecules, their safety, and the ability to decrease injection frequency. The primary criterion of expected efficacy of a molecule is a combination of the gain in visual acuity and resorption of retinal fluid. With regard to safety, experts recommend tighter follow-up for molecules currently in development, and at every scheduled visit, patients should be screened to identify early any potential adverse effects such as intraocular inflammation, retinal vasculitis or vascular occlusion. Experts also emphasize the importance of the packaging of the biological, with a preference toward prefilled syringes. Injection frequency is a key factor, and the authors recommended aiming for a maximal injection interval of 12 to 16 weeks. The stability of that maximum interval is also an important factor to consider in treatment selection.; Le choix d’un traitement de 1re intention pour optimiser les résultats à long terme est un enjeu majeur de la prise en charge des patients atteints de DMLA néovasculaire. Dans un contexte actuel de molécules en développement est apparue la nécessité d’identifier les critères indispensables à prendre en compte lors de la mise en place d’un traitement chez un patient naïf atteint de DMLA néovasculaire afin de garantir un rapport bénéfice/risque optimal à long terme. Cet article propose un consensus établi selon la méthodologie de type Delphi (en intégrant une gradation dans les consensus en fonction de l’analyse du taux de convergence des réponses) qui pourrait constituer une aide pour les ophtalmologistes pour l’initiation et le suivi du traitement des patients atteints de DMLA néovasculaire. Quatorze questions ont été soumises à un panel de 93 experts rétinologues français. Treize questions (93 %) ont obtenu un consensus (≥ 50 % de réponses consensuelles). Les experts recommandent ainsi de prendre en compte en priorité l’efficacité et la rapidité d’action respectives des molécules, leur sécurité d’utilisation ainsi que leur capacité d’espacement des injections. Le critère d’efficacité attendu en priorité d’une molécule est la combinaison de l’amélioration de l’acuité visuelle et de l’assèchement des fluides. En matière de sécurité d’utilisation, les experts recommandent une surveillance supplémentaire pour les molécules actuellement en développement, et ce à toutes les visites programmées, visant à détecter précocement d’éventuels effets indésirables tels que l’inflammation intraoculaire et accordent une place importante au conditionnement de la molécule. La capacité d’espacement des injections est importante à prendre en compte et il est recommandé d’atteindre un intervalle maximal compris entre 12 et 16 semaines. La stabilité de l’intervalle maximal atteinte par les patients est également un critère de choix important.

Choosing a first-line treatment to optimize long-term outcomes is a major challenge for treating patients with neovascular age-related macular degeneration (AMD). The development of several new molecules makes it critical to identify the relevant factors to consider so as to provide an optimal risk-benefit ratio when initiating a treatment in naïve patients with neovascular AMD. This paper proposes a consensus established with the Delphi method (which includes a gradation in a consensus based on an analysis of the convergence rate of answers) to provide criteria that guide the ophthalmologist's decision for treatment initiation and follow-up in neovascular AMD patients. Fourteen questions were submitted to 93 French retina experts. Thirteen (93%) of the questions reached a consensus (≥50% of answers consensual). The criteria recommended to take into account were both efficacy and onset of action of the molecules, their safety, and the ability to decrease injection frequency. The primary criterion of expected efficacy of a molecule is a combination of the gain in visual acuity and resorption of retinal fluid. With regard to safety, experts recommend tighter follow-up for molecules currently in development, and at every scheduled visit, patients should be screened to identify early any potential adverse effects such as intraocular inflammation, retinal vasculitis or vascular occlusion. Experts also emphasize the importance of the packaging of the biological, with a preference toward prefilled syringes. Injection frequency is a key factor, and the authors recommended aiming for a maximal injection interval of 12 to 16 weeks. The stability of that maximum interval is also an important factor to consider in treatment selection.

This is a retrospective case series of three patients presenting with syphilitic chorioretinitis. The diagnosis of syphilis rests on the ophthalmologic clinical exam as well as serologic confirmation. We studied the en face and SD-OCT images upon first consultation and after one month of antibiotic treatment with penicillin G.Four eyes of three male patients between 40 and 60 years of age all diagnosed with syphilitic placoid chorioretinitis were studied by en face OCT. Visual acuities upon initial presentation were unrecordable. On all the en face OCT examinations of the three patients, numerous small hyperreflective oval lesions were observed within the ellipsoid line and the retinal pigment epithelium around the macula. These lesions corresponded to small elevated nodules in the retinal pigment epithelium and interruptions in the ellipsoid line observed on SD-OCT. One month after treatment for neurosyphilis, the visual acuity had improved, and the outer retinal lesions had partially reversed in these eyes.We documented the characteristic lesions of syphilitic placoid chorioretinitis by en face OCT. En face OCT allows a more precise approach to the outer retina for diagnosis and follow-up as well as in understanding the pathophysiology of the disease.

We report a rare case of quinine toxicity causing acute bilateral blindness, followed by documented partial recovery within 24 hours. The patient was treated with hyperbaric oxygenotherapy and intravenous nitrates. Visual defects persist after 6 months.

Nous presentons le cas d’une femme de 52 ans adressee en mars 2013 aux urgences ophtalmologiques pour baisse d’acuite visuelle bilaterale. L’acuite visuelle est de 1/10e aux deux yeux. L’examen du fond d’œil montre un aspect de liquide sous retinien organise en strates successives au niveau du pole posterieur sur les deux yeux (Fig. 1). La tomographie par coherence optique en haute definition (5 lignes verticales) confirme la presence de liquide sous retinien avec des decollements sereux retiniens superposes d’âges differents (Fig. 2). L’angiographie a la fluoresceine nous montre aux temps tardifs une diffusion de fluoresceine au niveau du nerf optique qui confirme l’œdeme papillaire, une plage hypofluorescente qui correspond a un effet masque du liquide sous retinien, et en extreme peripherie un arret brusque

Resume Introduction Le syndrome des taches blanches evanescentes multiples (MEWDS) est une pathologie retinienne rare, responsable d’une baisse d’acuite visuelle brutale, le plus souvent unilaterale et dont la physiopathologie reste encore meconnue. L’objectif de ce travail a ete de mieux localiser les couches retiniennes lesees grâce a une nouvelle technologie : la tomographie par coherence optique avec reconstruction « en face » (OCT « en face »). Methodes Une patiente de 21 ans, presentant un MEWDS bilateral, a beneficie de la realisation d’un OCT Cirrus ® avec reconstructions « en face » des differentes couches retiniennes et de la choroide interne, d’une angiographie a la fluoresceine et d’une angiographie au vert d’infracyanine (ICG). Resultats L’OCT « en face » permet de localiser les lesions au niveau de la ligne de jonction segments internes/segments externes des photorecepteurs et de la choroide interne. Les images obtenues montrent des taches sombres aux contours identiques a ceux des lesions visualisees en angiographie ICG. Conclusion L’OCT « en face » est une technologie nouvelle, non invasive, capable de mettre en evidence dans le MEWDS des lesions de la ligne de jonction segments internes/segments externes des photorecepteurs, organisees en taches d’un motif identique a celui visualise en angiographie ICG.

Anti-VEGF therapies have revolutionized the treatment of neovascular age-related macular degeneration (AMD).The goal of this study was to evaluate the "real life" visual and anatomical outcomes of aflibercept treatment for treatment-naive patients with exudative AMD.This was a retrospective study of patients treated with aflibercept in the department of Ophthalmology at the University Hospital of Bordeaux between November 2013 and July 2015. The follow-up period varied from 3months to 2years. All patients received an induction phase with 3monthly intravitreal injections (IVT) followed by personalized monitoring. ETDRS best-corrected visual acuity (BCVA), fundus examination and OCT were performed at each visit. Data were collected at day 0, 3 months, 6, 9, 12months, 18 and 24months.Forty-three eyes of forty patients, mean age 77.7years, were included, with a minimum of 3months follow-up. Twenty-five eyes were followed for 1year; 5 eyes for two years. At baseline, the mean BCVA was 55.7 letters. Patients received 7.5 injections on average the first year and 2.6 the 2nd year. The mean gain of visual acuity was +7.3 letters at 3 months, +6.2 letters at 12 months, and +6.8 letters at 2years. Anatomically, the OCT data showed a decline of all parameters. The central macular thickness decreased by 118.3μm at 3months, 136.4μm at 12months and 65.5μm at 2years.Aflibercept can achieve effective visual and anatomical outcomes with results, which approach the pivotal studies, despite the use of personalized protocols and longer monitoring intervals.

Resume Objectif Decrire les caracteristiques sociodemographiques, cliniques et paracliniques des patients ayant un œdeme papillaire unilateral consultant aux urgences ophtalmologiques. Patients et methodes Il s’agit d’une etude retrospective observationnelle des patients avec un œdeme papillaire unilateral, consultant aux urgences ophtalmologiques du centre hospitalo-universitaire de Bordeaux, entre le 1er octobre 2008 et le 31 octobre 2009. Resultats Nous avons inclus 52 patients avec un œdeme papillaire unilateral. On comptait 61,5 % de femmes (n = 32) et 38,5 % d’hommes (n = 20). La moyenne d’âge etait de 53,5 ans (σ = 22,9 ans), avec un âge plus eleve pour les hommes que pour les femmes (61,1 ans vs 48,7 ans avec p = 0,05). Le diagnostic retenu etait une neuropathie optique ischemique anterieure aigue pour 27 patients, une neuropathie optique inflammatoire pour 17 patients, une hypertension intracrânienne pour trois patients et un « pseudo-œdeme papillaire » pour deux patients. Quant aux trois patients restants, le diagnostic etiologique precis de l’œdeme papillaire n’a pas ete fait. Conclusion Cette etude a evalue la prise en charge des patients atteints d’un œdeme papillaire unilateral consultant aux urgences ophtalmologiques. Elle aurait ainsi aide a l’amelioration de nos pratiques.

Tuberculosis (infection by Mycobacterium tuberculosis) remains a public health problem with increasing incidence. The diagnosis of primary ocular tuberculosis is troublesome because of the low sensitivity and poor specifity of routine diagnostic methods and the problems obtaining reliable samples. We report the cases of two patients, one immunocompromised male and one immunocompetent male, presenting chorioretinitis with high clinical suspicion of ocular tuberculosis. We performed serologies, polymerase chain reaction tests in aqueous humor, a purified protein derivative skin test, and measurement of interferon-gamma in whole blood using the QuantiFERON-TB Gold assay. The QuantiFERON-TB Gold assay was positive in both cases, in agreement with the diagnosis of ocular tuberculosis. The purified protein derivative skin test was positive in one case. The whole blood interferon-gamma assay is a precious tool for detecting extrapulmonary tuberculosis, especially in cases of primary ocular disease.

We report a rare case of quinine toxicity causing acute bilateral blindness, followed by documented partial recovery within 24 hours. The patient was treated with hyperbaric oxygenotherapy and intravenous nitrates. Visual defects persist after 6 months.

Multiple evanescent white dot syndrome (MEWDS) is a rare, usually unilateral, retinal disease associated with transient loss of vision. Its pathogenesis remains elusive. The purpose of this study was to determine the spatial location of the lesions in the neurosensory retina of a patient with MEWDS, using a new technology, i.e. "en face" optical coherence tomography ("en face" OCT).A 21-year-old woman presenting with bilateral MEWDS underwent Cirrus(®) OCT with advanced "en face" reconstructions of the various retinal layers and inner choroid, fluorescein angiography, and infracyanine green angiography (ICGA).During the acute stage of MEWDS, advanced "en face" visualization mode of the IS/OS photoreceptor junction and the inner choroid showed areas of strong signal attenuation, forming a spot pattern identical to that of the hypofluorescent IGCA dots. One month later, visual acuity returned to 20/25 in both eyes and the reflectivity map of the IS/OS junction and inner choroid displayed no areas of signal attenuation."En face" OCT is a new, noninvasive technology, capable of visualizing specific attenuation of the IS/OS junction in MEWDS, which form a spot pattern identical to those revealed by ICGA.

Alport syndrome is a progressive inherited glomerulonephritis leading to renal failure, hearing loss and ocular changes.To report the seventh case of giant macular hole in a patient with Alport syndrome, review the literature, and propose a pathophysiological mechanism.The case of a man with a giant macular hole of the right eye is described with visual acuity, fundus photographs and spectral domain ocular coherence tomography.A 56-year-old man with Alport syndrome and giant macular hole (2291 μm × 2265 μm) in his right eye, reducing the visual acuity to 20/200, complained of progressive visual loss in his contralateral eye. Fundus examination of the left eye revealed a circular perimacular atrophy.Giant macular holes are one possible retinal complication of Alport syndrome. Their pathogenesis differs from idiopathic macular holes and may result from the combination of collagen type IV abnormalities in the basement membranes of both Bruch's membrane and the internal limiting membrane, along with anomalous vitreo-retinal adhesion.

Choroidal osteoma is a rare, ossifying tumor, which, while benign, may be complicated by choroidal neovascularization.An 11-year-old boy presented with blurred vision in the right eye for few days. Fundus examination showed bulky lesion in the posterior pole containing a sub-retinal hemorrhage. The geographic borders and color of the mass were typical of choroidal osteoma despite the unusual macular location. The diagnosis was confirmed by ultrasonography. The patient was treated with three successive intravitreal injections of 1.25 mg/0.05 mL bevacizumab (IVB) under general anesthesia, due to recurrences of neovascular activity. SD-OCT in EDI mode was carried out prior to each injection.SD-OCT before and after each bevacizumab injection confirmed regression of serous retinal detachment (SRD) at various locations throughout the lesion, especially in the hemorrhagic zone. It also allowed us to differentiate the active decalcified zones from the inactive calcified zones and to follow treatment response.The treatment of choroidal neovascularization (CNV) secondary to choroidal osteoma is not well defined. As for other etiologies of CNV, anti-VEGF agents (such as bevacizumab) appear to be effective in regressing CNV and improving visual function. In our young patient, general anesthesia was necessary to administer each injection. SD-OCT allows diagnostic confirmation and follow-up of treatment. EDI mode is helpful in studying the choroid and the osteoma.We report a rare case of macular choroidal osteoma, examined by SD-OCT. CNV required several anti-VEGF injections, with good anatomical and functional results.

To study the epidemiologic and clinical characteristics of patients with unilateral optic disc edema diagnosed in the emergency room (ER).Retrospective observational study of all cases of unilateral optic disc edema seen in the ophthalmology ER of Bordeaux University Hospital, France, between October 1, 2008 and October 31, 2009.Fifty-two patients with unilateral optic disc edema were studied, including 61.5% women (n=32) and 38.5% men (n=20). Mean age was 53.5 years (± 22.9). Male patients were older than female (61.1 years vs 48.7 years, P=0.05). Final diagnosis was anterior ischemic optic neuropathy (27 cases), papillitis (17 cases), papilledema (three cases), and pseudoedema (two cases). No etiologies were identified for the remaining three patients.Our study discusses the diagnostic approach for patients presenting with unilateral optic disc edema; this discussion may help to improve clinical practice.