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Background and Purpose: Optimal surgical resection improves the prognosis of glioblastomas. However, this goal is far from being achieved due to its invasive nature. Several studies have already shown the efficacy of fluorescence-guided surgery, in improving the quality of resection of glioblastoma. We report herein our experience through a retrospective serie and describe the principles, limitations and advantages of this technique., Methods: Between 2006 and 2009, 22 patients underwent resection of a glioblastoma guided by fluorescence. Following operations, all patients underwent sequential clinical examination and radiological monitoring using multimodal MRI. The extent of resection was assessed by the surgeon during the procedure and by the radiologist on MRI. The curves of progression-free clinical survival (SSP) and overall survival (SG) were analyzed. The prognostic value of the extent of resection was studied., Results: We obtained 68.2% of complete resection according to the absence of residual fluorescence as assessed by the surgeon, and 75% according to the absence of residual tumor on early MRI. The median SSP was 10.75 months and the median SG was 17 months. Complete tumoral resection confirmed by loss of fluorescence significatively increases the median SSP of 6.7 months to 12.9 months (p=0.001559) and the median SG of 12.3 months to 20.9 months (p=0.000559). After 1 year, 81.8% of patients were still alive., Conclusions: Our study confirms the use of fluorescence as an effective method to allow optimal resection of glioblastoma. In addition to neuronavigation, surgical experience, vision and proprioception, fluorescence contributes to achieve a complete tumor resection., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Familial exudative vitreoretinopathy (FEVR) is a well-defined inherited disorder of retinal vessel development. Association of FEVR with other congenital ocular diseases has already been described. We report the first clinical case of FEVR associated with hyaloid artery persistence. An 18-year-old Tunisian woman and four members of her family (mother, two brothers, and sister) presented signs of FEVR. Examination of this patient also revealed functional hyaloid artery persistence in her right eye. These two disorders have many common aspects in their pathological process, in particular vascular endothelial growth factor expression, which can explain this association.

Surgical treatment of age-related macular degeneration has been developed since 1991 when the limitations of photocoagulation were demonstrated: it is suitable for few patients, high recurrence rate, and immediate loss of visual acuity for subfoveal membranes. This article will review the different procedures: surgical excision, macular translocation, and macular rotation. We will attempt to clarify the surgical indications, taking into account of the early results of dynamic phototherapy. However, because of the lack of comparative studies, there is no definitive consensus regarding surgery for age-related macular degeneration.

We report the case of a 39-year old man who presented with central serous chorioretinopathy. Two months after diagnosis, argon laser photocoagulation was performed. One month later, the patient noticed distortion and a reduction in vision revealing a subretinal neovascularization above the fovea next to the laser scar. The patient underwent surgical extraction of the neovascular membrane and recovered a visual acuity of 20/30. This case report shows a complication of laser treatment of central serous chorioretinopathy and underlines the diagnostic difficulties of this disease and its treatment modalities. The surgical excision, the first reported in this etiology, led to good visual recovery, as is usually observed in young patients operated on for neovascular membrane.

Purpose: The aim of this study was to evaluate the direct effect of surgical treatment of subfoveolar neovascular membranes in age related macular degeneration to macular functions., Patients and Methods: Thirteen eyes of 13 patients were included in this study. Macular function was assayed by visual acuity and central visual field using the Octopus perimeter before surgery and in the first three post operative months. Pre and post operative fluorescein angiography frames were digitalized and the size of each lesions were compared., Results: After a 3 months follow up, visual acuity remained stable or improved in 66% of the patients. However, visual acuity was better than 0.1 in 15% of the patients. Central visual field comparison disclosed a significant worsening of the retinal sensitivity in the 3 degree field surrounding the central point. On fluorescein frames, submacular scar was 141% of the size of the neovascular membrane. After a mean follow up of 6.9 months (range 3-14), one case of recurrence occurred. A cataract was observed in 85% of the phakic patients followed for more than six months., Conclusion: After a short term follow up, surgery can stabilise visual acuity, even though it remains poor. A worsening of the scotoma in the 3 degrees surrounding the central point is observed. However, patients noticed a subjective visual improvement in 62% of the case.

Purpose: Age related macular degeneration (AMD) is the most common cause of legal blindness in the Western world in people over 50 years of age. The most severe visual loss occurs in patients with AMD complicated by choroidal neovascular membranes (CNV). Indocyanine green angiography (ICG) account for visualization in up to 60% of the cases that are classified as occult on fluorescein angiography (up to 70% of the cases). ICG-guided laser photocoagulation of CNV is currently a mater of debate. We conducted a pilot study to determine wether it could be beneficial for patients presenting with occult CNV on fluorescein angiography., Material and Methods: Twenty consecutive patients (20 eyes) with occult CNV in AMD were included. All showed occult CNV on fluorescein angiography and a well defined juxta- or extrafoveal hot spot or plaque hyperfluorescence on ICG. Fibrovascular retinal pigment epithelial detachments were excluded. The patients had serial controls, including fluorescein angiography and ICG, at 15 days, 1, 2, 3, 6, 9 and 12 months after photocoagulation., Results: At the end of follow-up visual acuity (VA) was stable (within +/- 3 lines) compared to the initial one in 80% (16) of the cases. A complete resolution of exudative signs was observed in 75% (15) of the cases., Conclusions: ICG-guided laser photocoagulation of occult CNV in AMD account for better visual acuity than natural course of the disease at 12 months follow-up. However, a prospective randomized clinical trial is warranted to evaluate definitively this treatment approach.

Background: Subfoveal choroidal neovascularization has usually a poor visual prognosis. Submacular surgery has been advocated as an alternative treatment. Visual results of this recent surgical technique is under current clinical evaluation., Methods: We retrospectively reviewed the charts of 16 eyes from 15 patients who underwent submacular surgery through a small retinotomy. Mean follow-up was 8 months (range from 5 to 88 weeks): group 1: submacular hemorrhages caused by age-related macular degeneration, 8 eyes; group 2: advanced subfoveal choroidal neovascularization in age-related macular degeneration, 3 eyes; group 3: young onset subfoveal choroidal neovascularization, 5 eyes., Results: Group 1: mean preoperative visual acuity was 0.024. Postoperative visual acuity increased for 5 eyes (63%) and decreased for 3 eyes (37%) (mean follow-up: 33 weeks). Two eyes had recurrent neovascularization. Group 2: mean preoperative visual acuity was 0.083. Postoperative visual acuity decreased for both eyes (mean follow-up: 58 weeks). Two eyes had recurrent neovascularization. Group 3: mean preoperative visual acuity was 0.082. Postoperative visual acuity increased for both eyes (mean follow-up: 26 weeks). Two eyes had recurrent neovascularization. In both groups, recurrent neovascularization was managed by laser photocoagulation., Conclusions: Surgery of subfoveal choroidal neovascular membranes may stabilize or improve visual acuity in young patients. In subfoveal choroidal neovascularization due to age-related macular degeneration. this technique does not provide currently measurable visual improvement except in cases complicated by submacular hemorrhage. Results of future trials comparing surgery with spontaneous evolution or laser photocoagulation are necessary.

In a group of 182 patients of under 50 years of age with subretinal neovascularization, the syndrome of hemorrhagic macular choroidopathy of the young adult was identified in 30 cases. This syndrome is characterized by the occurrence of a juxtafoveolar idiopathic neovascular membrane in an eye normal in all other respects. The natural course of this lesion is the production of a fibroglial scar leading to a mean final visual acuity of 0.15. The syndrome remains unilateral in 75 p. cent of cases, as shown by a mean follow-up of 23.9 months. Photocoagulation of these new vessels is possible, and in a group of 19 eyes it allowed conservation of a mean acuity of 0.6. This syndrome differs from ocular histoplasmosis where widespread uni- or bilateral involvement of the pigment epithelium and choriocapillaris is found. Hemorrhagic macular choroidopathy can also be distinguished from choroiditis associated with hemorrhages. The existence or the sequellae of uveitis, even when associated with subretinal new vessels arising from an atrophic chorioretinal scar, establishes the correct diagnosis. The etiology of hemorrhagic macular choroidopathy is unknown. It is possible that multiple etiologic agents might be responsible for different clinical syndromes in relation to endemic factors.

The destruction of senile neovascular membranes in the central avascular region of the macula using argon laser is difficult and associated with complications. Yellow pigment in this region absorbs the blue component of the conventional argon laser radiation. In this study, we compared laser of different wavelenghts: red krypton and green argon. Light and electron microscopic studies on non-human primates were performed at one hour and three weeks following laser burns. With the red krypton laser maximum damage was seen at the level of choriocapillaris and the choroïd, although the pigment epithelium was also destroyed. With the green argon laser the maximum absorption occurred at the level of the pigment epithelium. A clinical and angiographic study showed that the destruction of juxtafoveal neovascular membranes by both these lasers was possible after one or several treatment sessions. After an average follow-up period of 45 months, visual acuity was stable or improved in 10 out 17 eyes treated with the green argon laser and in 27 out of 53 eyes treated with the red krypton laser. Our results suggest that the red krypton laser offers a better alternative for the treatment of neovascular membranes located near the foveola since less unnecessary damage is induced. Outside the xanthophyllic area there is no major difference between the different wavelengths.

New vessels in senile macular degeneration threaten central vision. To evaluate the effects of treatment a randomized prospective trial was undertaken between 1977 and 1981. This trial concerned destruction of subretinal new vessels by argon laser photocoagulation. The indications of photocoagulation depended on the location of new vessels in relation to the center of the fovea. New vessels amenable to this treatment were those that were clearly visible on angiography and located farther than 100 microns from the foveola. 60 patients were divided into 3 groups according to the distance of the new vessels from the fovea: 100-200 microns away; 200-400 microns away; and greater than 400 microns away from the center of the fovea. In each group patients were randomly assigned to treatment or no treatment. After at least one year follow-up, argon laser showed a statistically significant effect (p less of 0,01; Kolmogorow-Smirnov test) on the stabilization or the amelioration of visual acuity compared with the non treated group. There was no statistical difference in the 3 groups of new vessel location. In cases of failure, no differences in final visual acuity existed between the treated and the non-treated group.