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Resume Introduction Le developpement de l’angiographie par tomographie par coherence optique (OCTA) dans la prise en charge des pathologies retiniennes permet de reduire les indications d’angiographie a la fluoresceine (AF). Depuis 2015, nous utilisons l’OCTA et nous nous efforcons de realiser le moins d’angiographie (AF) possible. Dans cette etude, nous decrivons les taux d’OCTA et d’AF realises et leur indication. Patients et methodes Etude descriptive retrospective monocentrique. Analyse des dossiers de patients examines pour une pathologie retinienne par un specialiste en retine medicale entre janvier 2015 et juin 2018. Resultats 3487 patients ont ete examines. Les dossiers de 651 d’entre eux (1170 yeux) ont ete selectionnes au hasard pour constituer le groupe etudie. L’âge moyen etait de 72 ans (60 % de femmes). 49,4 % des yeux ont eu un OCTA et 6,5 % une AF. Apres la premiere annee, le taux d’angiographie etait de 2 %. L’OCTA etait realisee principalement pour une degenerescence maculaire liee a l’âge (DMLA) et/ou une maculopathie liee a l’âge : 50 %, une chorioretinite sereuse centrale (CRSC) : 12 % et une occlusion vasculaire retinienne : 10 %. L’AF etait realisee principalement pour une DMLA : 49 % ; une retinopathie diabetique (RD) : 18 % et une CRSC : 14 %. 16 % des yeux souffrant de RD, 11 % de CRSC et 10 % de DMLA ont eu une AF (p Conclusion En pratique courante, l’OCTA etait realisee pour la moitie des yeux examines et l’AF pour seulement 6,5 % des yeux. Ce taux etait de 2 % apres la premiere annee d’utilisation de l’OCTA. La RD etait la principale pathologie necessitant une AF.

Non-invasive multimodal imaging, including optical coherence tomography angiography (OCTA), has demonstrated high sensitivity and specificity for the management of retinal diseases. Since the availability of OCTA in 2015, we have developed a policy of "as little fluorescein angiography as possible". In this study, we describe the rate of OCTA and fluorescein angiography (FA) performed and their indications.Retrospective descriptive single-centre study. Chart review of patients examined for retinal disorders by one medical retina specialist between January 2015 and June 2018.3487 patients were examined for a retinal disease. The charts of 651 of these patients (1170 eyes) were randomly selected for analysis (study group). The mean age in the study group was 72 years (60% female). Overall, OCTA and FA were performed in 49.4% and 6.5% of the studied eyes respectively. After the first year, the rate of FA decreased to 2%. The main indications for OCTA were age-related macular degeneration (AMD): 50%, central serous chorioretinopathy (CSC): 12% and retinal vascular occlusion: 10%. The most frequent indications for FA were AMD: 49%, diabetic retinopathy (DR): 18% and CSC: 14%. FA was performed in 16%, 11% and 10% of eyes diagnosed with DR, CSC and AMD respectively (P0.05).In routine practice, OCTA was performed in half of the eyes examined for a retinal disorder. The overall rate of FA was 6.5% and dropped to 2% after the first year of OCTA use. DR was the main disorder still requiring FA.

Resume Introduction Decrire une technique de deconditionnement extemporane du bevacizumab pour les injections intravitreennes (IVT) et rapporter le taux d’endophtalmie apres IVT. Patients et methodes Analyse retrospective des cas d’endophtalmie apres IVT realisees dans la salle dediee de classe ISO 7 d’un etablissement de sante entre janvier 2010 et decembre 2014. Le bevacizumab a ete preleve a travers un mini-spike muni d’un filtre. L’operateur portait un masque et des gants steriles. L’infirmiere portait un masque. Le flacon de bevacizumab etait detruit apres chaque seance. Resultats Six mille deux cent trente-six IVT de bevacizumab ont ete realisees. Un cas d’endophtalmie est survenu (1/6236 ; 0,016 %). Pendant cette periode, 4 endophtalmies post-IVT d’autres produits ont ete notees (4/32 992 ; 0,012 % ; p = 0,8). Conclusion Le deconditionnement extemporane du bevacizumab a travers un mini-spike est une technique simple et sure qui peut faciliter l’utilisation du bevacizumab dans le traitement des pathologies retiniennes. Le risque d’infection post-IVT est tres faible.

To describe a technique for extemporaneously drawing up bevacizumab for intravitreal injection (IVT) and report the rate of post-injection endophthtalmitis.Retrospective monocentric analysis (January 2010-December 2014) of all IVT of bevacizumab drawn up with the following technique: in the operating room (class ISO 7) through a mini-spike with an integrated bacteria retentive air filter. The surgeon was wearing sterile gloves and a mask. The assisting nurse wore a mask. The bevacizumab vial was discarded at the end of each session.Six thousand two hundred and thirty-six bevacizumab injections were performed. One case of endophthalmitis was noted (0.016%). During the same period, 4 cases of endophthalmitis were found after IVT of other drugs (4/32,992; 0.012%. P=0.8).Intravitreal injection of bevacizumab after extemporaneous withdrawal through a mini-spike filter is a simple and safe technique. The risk of postoperative endophthalmitis is very low. This simple technique facilitates access to compounded bevacizumab.

But Decrire les avantages de la vitrectomie assistee par triamcinolone pour identifier les causes d’echec de la vitrectomie de premiere intention dans le traitement du decollement de retine par trou maculaire du myope fort. Observations Nous rapportons les cas de trois patients myopes forts ayant presente une recidive de decollement de retine par trou maculaire apres avoir ete traites initialement par vitrectomie avec creation du decollement posterieur du vitre, pelage de la surface retinienne et injection de SF6. Lors de la recidive, aucune traction residuelle ni dehiscence autre que le trou maculaire n’etait visualisee. La reprise chirurgicale avec injection de triamcinolone au cours de la vitrectomie a mis en evidence la persistance de reliquat de hyaloide posterieure ou de membrane friable et fortement adherente a la retine qui ont pu etre disseques dans tous les cas. Ces trois reinterventions ont conduit a un succes anatomique. Conclusion L’injection de triamcinolone ameliore la qualite de la vitrectomie dans le traitement des decollements de retine chez les myopes forts. La vitrectomie assistee par triamcinolone permet la visualisation de reliquats de hyaloide ou de membrane epiretinienne pouvant etre source de traction sur la retine et expliquer les echecs de la vitrectomie. Le pelage de ces structures transparentes a permis le succes de l’intervention.

To report the use of triamcinolone-assisted vitrectomy to assess the cause of vitrectomy failure in the treatment of retinal detachment due to myopic macular hole.We report the cases of three myopic patients presenting with recurrent retinal detachment due to macular hole after initial vitrectomy treatment with posterior vitreous detachment, a systematic attempt at membrane peeling, and gas injection (SF6). No retinal traction or tear other than the macular hole was observed. The recurrence of retinal detachment was treated with vitrectomy and intraoperative use of triamcinolone, which demonstrated persistent posterior hyaloid and thin and strongly adherent membrane remnants in each case. Anatomic success was obtained after peeling these structures.Intraoperative use of triamcinolone reduces the risk of overlooking hyaloid or membrane remnants during vitrectomy for the treatment of myopic retinal detachment. Transparent remnants of posterior hyaloid and membranes were visualized by triamcinolone-assisted vitrectomy. They could lead to traction on the retina and explain the failure of the initial vitrectomy. Anatomic success was obtained after peeling these structures.

To describe the results of radial optic neurotomy for the treatment of severe central retinal vein occlusion.Prospective noncomparative single-center study. Analysis of ten eyes of ten consecutive patients whose visual acuity was 0.1 or less. They underwent fluorescein angiography, visual field testing by automated perimetry, and macular thickness analysis by optical coherence tomography preoperatively at 3 months and at 6 months postoperatively.Mean visual acuity on an ETDRS chart increased from 30+/-12 points preoperatively to 42+/-15 points at the 3-month visit, (p=0.03), and mean macular thickness decreased from 580+/-150 micro m to 361+/-52 micro m (p=0.04). All patients had clinical improvement as determined by fundus examination and fluorescein angiography. An improvement in the central visual field was observed in all eyes. Mean visual acuity of the five patients followed-up for 6 months was 52.8+/-20 points. No visual loss was observed. None of the patients underwent laser photocoagulation or has presented with neovascularization so far. Optociliary veins developed in three eyes and a retinochoroidal anastomosis within the disk incision was observed in two eyes.These preliminary results are encouraging when compared to the reported natural progression of severe central retinal vein occlusion. A bypass of the site of occlusion is a possible mechanism for radial optic neurotomy. A randomized study should be conducted to assess the efficacy of radial optic neurotomy and determine the best candidates for surgery.

Internal limiting membrane peeling has recently given interesting results in the management of macular edema in diabetic patients, even in the absence of vitreomacular tractions. This study was conducted to evaluate the results of a surgical treatment for macular edema resulting from branch retinal vein occlusion.A nonrandomized prospective study was conducted between March 2001 and April 2002 on 12 eyes of 12 consecutive patients with a visual acuity of 20/40 or less resulting from branch retinal vein occlusion with macular edema. Internal limiting membrane peeling associated with arteriovenous crossing sheathotomy was performed on six eyes and internal limiting membrane peeling alone was performed on six eyes. Patients were tested with ETDRS visual acuity, fluorescein angiography, automated perimetry, and OCT pre- and postoperatively (at 3 and 6 months).At 6 months, postoperative visual acuity was improved in all patients (mean VA=20/40; range, 20/125-20/20), with an average gain of three lines of vision (or 14 ETDRS points) (p=0.002). Fundus examination and fluorescein angiography results were improved in all patients. At 6 months, on automated field testing, the mean corrected defect improved from 3.4+/-0.9dB to 2.3+/-0.9dB (p=0.008). On OCT, mean foveal thickness decreased from 419+/-57 micro m to 233+/-10 micro m (p=0.02). No difference was noted between simple vitrectomy with internal limiting membrane peeling and arteriovenous crossing sheathotomy in terms of visual acuity (p=0.5), visual field (p=0.2), or foveal thickness (p=0.6) improvement.Our findings suggest that internal limiting membrane removal for macular edema may improve the functional prognosis in patients with branch retinal vein occlusion. Adventitial sheathotomy did not yield further functional benefits in these cases.

A 67-year-old woman had three different tumors of the eyelids. The most prominent one was a nevus of the free margin of the inferior left eyelid. The nevus was followed for 18 months without change while two epidermal papillomatous tumors grew and were surgically removed. Histopathology disclosed that one tumor was a seborrheic keratosis and the other was a pre-epitheliomatous keratosis. Histologic evaluation of the margins showed that surgical removal was complete. A regular examination of the scars was recommended to the patient.

Due to a long-term alteration in their chemical composition, resulting in excessive swelling, Miragel scleral buckles are now commonly removed. The aim of this study was to determine the characteristics and the outcome of patients needing Miragel buckling removal.Retrospective analysis between 1997 and 1999 of the charts of patients successfully treated for retinal detachment and in whom a Miragelepiscleral buckle was removed after surgery with a minimal follow-up of 6 months after removal.The study group consisted of 24 eyes of 13 women and 11 men. Their mean age at removal was 47.1+/-18.4 years. The removed buckle was encircling in nine cases (37.5%), circumferential (180 degrees ) in 11 cases (45.8%) and radial in four cases (16.7%). An exposed buckle was observed in two cases (8.3%). Reasons for removal were excessive swelling of the buckle inducing ocular motility disturbance in 23 cases and infection of an extruded buckle in only one case. The mean time between implantation and removal was 91.9+/-28.7 months (range 20-120). One case of scleral perforation during removal and one case of retinal redetachment were observed. Three cases of persistent ocular motility disturbance after removal were also noted.Late swelling of the buckle was the main reason for removal. Patients undergoing Miragel buckling removal should be informed of scleral perforation during removal, retinal redetachment and persistence of ocular motility disturbance as possible complications.

A clinicopathologic case of a 41-year-old female patient exhibited a single cutaneous tumor at the inner part of the free margin of the inferior left eyelid. It was a pink, fleshy, and nodular well-circumscribed exophytic mass with thin vessels on its surface. Experienced already for 20 years, this lesion had been observed 6 years before and has not exhibited much change since then. However, its clinical appearance argued for a possible small basal cell carcinoma, which had grown over the inferior left lachrymal duct. After surgical removal, histopathology showed that the tumor was an amelanotic dermal nevus. No disturbance of lachrymal drainage was observed after surgery. This case shows that nodular amelanotic tumors of the eyelid, even when located on the inner segment of the eyelid, may be a nevus.

A 46-year-old female patient had a tumor of the free margin area of the superior right eyelid, appearing as the fourth recurrence of a primary lesion, occurring 24 years before. The lesion was covered with a thick layer of keratin, giving it a grayish and black color. Excision was performed without involving the free margin. Histopathology disclosed that the tumor was a seborrheic keratosis, which was not completely removed. As the lesion was benign, no further surgery was performed but regular examination was recommended to the patient.

Retinal detachment (RD) is a major complication of cataract surgery, which can be treated by either primary vitrectomy without indentation or the scleral buckling procedure. The aim of this study is to compare the results of these two techniques for the treatment of pseudophakic RD.The charts of 40 patients (40 eyes) treated with scleral buckling for a primary pseudophakic RD were retrospectively studied and compared to the charts of 32 patients (32 eyes) treated with primary vitrectomy without scleral buckle during the same period by the same surgeons. To obtain comparable samples, patients with giant retinal tears, vitreous hemorrhage, and severe preoperative proliferative vitreoretinopathy (PVR) were not included. Minimal follow-up was 6 months.The primary success rate was 84% in the vitrectomy group and 82.5% in the ab-externo group. Final anatomical success was observed in 100% of cases in the vitrectomy group and in 95% of cases in the ab-externo group. Final visual acuity was 0.5 or better in 44% of cases in the vitrectomy group and 37.5% in the ab-externo group. The duration of the surgery was significantly lower in the ab-externo group, whereas the hospital stay tended to be lower in the vitrectomy group. In the vitrectomy group, postoperative PVR developed in 3 eyes and new or undetected breaks were responsible for failure of the initial procedure in 2 eyes.Primary vitrectomy appears to be as effective as scleral buckling procedures for the treatment of pseudophakic RD.

The authors report a case of unilateral, stable, localized, and well-circumscribed choriocapillaris atrophy associated with retinal pigment epithelium dispersion and atrophy. The anterior segment was normal. Facial examination revealed a homolateral malar hypoplasia. The other eye was normal. The electrophysiologic study did not confirm pigmentary degeneration of the retina. The patient's history included a difficult delivery using obstetrical forceps. The authors review the main ocular lesions secondary to birth trauma. In this case, they favored a traumatic chorioretinal lesion secondary to an obstetrical traumatism. In this context, progressive facial hemiatrophy is the main differential diagnosis.

to evaluate the efficacy and the safety of low dose intraocular tissue plasminogen activator (rt-PA) in the treatment of traumatic hyphema and postoperative fibrinous membrane.Six microg to 10 microg of rt-PA was injected into the anterior chamber to treat severe fibrinous postoperative membranes and total traumatic hyphemae.Thirteen eyes of 13 patients were treated. Four cases of traumatic hyphema and 9 cases of fibrinous membranes were included. Complete fibrinolysis within 24 hours was observed in 4 cases (30.8%). A partial success was noted in 7 eyes (53.8%). No beneficial effect was observed in two cases of traumatic hyphema associated with intravitreal hemorrhage after penetrating trauma. No side effect attributable to rt-PA occurred.Low dose intraocular rt-PA appears to be safe and effective in the treatment of postoperative fibrinous membrane and endocular hemorrhage limited to the anterior chamber.

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.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.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.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.

To investigate whether peroperative perfluorocarbon liquids (PFCL) improve the long term anatomical success of retinal detachment associated with severe proliferative vitreoretinopathy (PVR).The charts of 62 successive patients operated on for retinal detachment associated with severe PVR were retrospectively analyzed. For one group of 39 patients PFCL were used intraoperatively to improve membrane dissection. The anatomical status of the two groups were compared one month after surgery and at least 6 months after silicone oil ablation.Anatomical success was observed in 84.6% in the group of patients operated with PFCL compared to 52% in the other group (P = 0.005). At the end of the follow up, anatomical success was observed in 64% of patients operated with PFCL compared to 61% in the control group (P = 0.8). However, recurrences were observed later in the group operated on with PFCL.Perfluorocarbons liquids significantly improve the initial reattachment of retinal detachment complicated with severe PVR, but they do not seem to improve their final anatomical status.

We report a case of a persistent hyaloid artery in a 69 year old man. The exam of the right eye and the anterior segment of the left eye disclosed a mild cataract. Fundus examination of the left eye revealed a persistent hyaloid artery emerging from the optic disc, surrounded by primary vitreous on its anterior end, inserting on the nasal pre equatorial retina. Macular ectopia and sectorial chorioretinal atrophy were also present. Fluorescein angiography disclosed a permeable and tight hyaloid artery. There were no macular or optic nerve anomalies precluding visual acuity. After phakoemulsification, the patient regained a visual acuity of 0.9 on the left eye.

Objectif Cette etude a pour but d’analyser et de comparer la frequence, l’aspect et le devenir des dechirures et des decollements de retine survenant apres chirurgie maculaire par vitrectomie avec sclerotomies sans suture 23 gauge a la vitrectomie « traditionnelle » 20 gauge. Materiels et Methodes Une etude retrospective a compare un groupe comprenant toutes les chirurgies maculaires (trou maculaire, membrane et traction epiretinienne, et œdeme maculaire) operees par vitrectomie 23 gauge entre juillet 2007 et juillet 2008 a un groupe opere par vitrectomie 20 gauge entre octobre 2004 et octobre 2006 par les deux meme chirurgiens. Resultats 153 yeux ont ete inclus dans le groupe 23 gauge. Un decollement de retine est survenu en postoperatoire (0,6 %) contre 7 cas sur 253 (2,8 %) dans le groupe 20 gauge. (P = 0,14). Discussion Le decollement de retine etait une complication moins frequente dans le groupe 23 gauge. Neanmoins, des effectifs plus etoffes dans chaque groupe sont necessaires afin de determiner si cette tendance se confirme significativement. Si tel est le cas, un plus faible debit d’aspiration en cours de vitrectomie et un moindre volume de vitre incarcere dans les sclerotomies pourrait expliquer cette difference. Conclusion Le decollement de retine est une complication rare apres vitrectomie 23 gauge. Des effectifs nombreux sont indispensables pour determiner si cette technique de vitrectomie reduit le risque de decollement de retine.

Introduction Le but de cette etude est de presenter le devenir des patients beneficiant d’un traitement anti-aggregant plaquettaire et operes de chirurgie vitreo-retinienne. Materiels et Methodes Une etude retrospective a ete realisee. Les dossiers de 37 patients (41 interventions) operes entre janvier 2006 et octobre 2007 ont ete etudies. Les elements suivants ont ete pris en compte : arret du clopidogrel ou non avant l’intervention, prise concomitante d’aspirine, presence d’une hypertension arterielle ou d’un diabete, indication operatoire, type d’intervention realisee, survenue d’une hemorragie per operatoire ou postoperatoire, devenir de l’œil opere. Resultats Trois cas (8 %) d’hemorragies postoperatoires ont ete observes. Dans tous ces cas le clopidogrel n’avait pas ete stoppe avant l’intervention. Dans deux cas, il s’agissait d’une hemorragie supra choroidienne qui a recidive malgre une ou plusieurs interventions supplementaires ce qui a conduit a la perte de la vision. Discussion Aucun cas d’hemorragie per ou post-operatoire n’a ete observe lorsque le clopidogrel a pu etre arrete avant l’intervention de chirurgie vitreo-retinienne. Conclusion La survenue d’une hemorragie dans les suites d’une chirurgie vitreo retinienne chez un patient sous clopidogrel n’est pas frequente mais semble de mauvais pronostic lorsque ce traitement ne peut etre arrete.

Introduction Plusieurs etudes ont suggere l’interet de l’injection intravitreenne de bevacizumab dans le traitement de la DMLA neovasculaire. Le but de cette etude est : - d’etudier le devenir des patients dont l’examen clinique et angiographique 4 semaines apres l’injection ne met en evidence aucune amelioration ; - de degager des facteurs permettant de predire l’absence d’amelioration a cette date. Materiels et Methodes Etude retrospective multicentrique analysant les dossiers des patients ayant beneficie d’une injection intravitreenne de 0,05 mg de bevacizumab pour une DMLA neovasculaire apres consentement eclaire. Tous les patients ont beneficie d’un examen clinique, angiographique et OCT avant et 4 semaines apres l’injection. Resultats L’etude comprend 127 yeux de 121 patients (âge moyen 77 ans). Vingtneuf yeux (23 %) n’ont pas ete ameliores sur l’OCT et l’angiographie a la fluoresceine a la quatrieme semaine. Le suivi median apres l’injection etait de 18 semaines. Onze yeux ont ete ensuite traites par une nouvelle injection qui a permis une amelioration anatomique dans 7 cas. Trois cas de dechirure de l’epithelium pigmente et 3 cas d’hematome maculaire ont ete notes. Les patients non repondeurs a 4 semaines avaient une plus mauvaise acuite visuelle avant injection (P = 0,03). Discussion L’absence d’amelioration anatomique 4 semaines apres injection de bevacizumab n’est pas rare. Les patients non repondeurs a 4 semaines avaient une acuite visuelle significativement plus mauvaise avant injection. Conclusion L’absence d’amelioration anatomique 4 semaines apres injection de bevacizumab n’est pas rare. Une nouvelle injection a permis une amelioration dans les deux tiers des cas avec un suivi court. Les patients non repondeurs a 4 semaines avaient une acuite visuelle significativement plus mauvaise avant injection.

Introduction L’œdeme maculaire de l’obliteration veineuse retinienne reste une complication a risque de malvoyance en cas de bilateralisation. Le mecanisme est multi factoriel expliquant l’absence de consensus therapeutique. Presentation de 4 patients âges de plus de 65 ans, strictement monophtalmes apres complications d’obliteration veineuse retinienne anterieure et presentant une recidive controlaterale plusieurs annees apres, avec œdeme maculaire. Objectifs et Methodes Evaluation du statut visuel et du retentissement social a 12 mois apres strategie therapeutique reflechie entre le patient et l’ophtalmologiste. Recueil des donnees pour chaque patient : interrogatoire oriente, acuite visuelle loin/pres, tonus oculaire, fond d’œil, angiographie et OCT. Exclusion des œdemes maculaires avec composante tractionnelle. 2 cas : perte plus ou moins complete de l’autonomie : choix d’un traitement chirurgical. 2 autres cas : aucune alteration des activites courantes malgre un important œdeme maculaire menacant a long terme le pronostic visuel : choix d’un traitement medical. Observation Les moyens therapeutiques invasifs, reserves aux 2 premiers cas ont permis d’ameliorer leur fonction visuelle et de reprendre leur activite quotidienne sans aucun effet indesirable. Le choix d’un traitement medical et/ou d’une surveillance simple pour les 2 derniers cas n’a pas modifie leur activite courante et a permis dans un cas d’observer une disparition complete de l’œdeme maculaire. Discussion Il n’existe pas actuellement de conduite a tenir claire face a l’œdeme maculaire apres obliteration veineuse retinienne. De nombreuses etudes multicentriques regionales sont en cours pour preciser la place des differents traitements face a l’œdeme maculaire potentiellement invalidant. Conclusion La presentation de ces 4 situations cliniques montrent que le choix therapeutique reste essentiellement guide par l’importance et l’evolution de la baisse d’acuite visuelle en tenant compte egalement du retentissement social. Ces exemples pourraient egalement aider a definir un organigramme decisionnel.