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Purpose: To investigate the association of commonly used systemic medications with glaucoma and intraocular pressure (IOP) in the European population. Design: Meta-analysis of eleven population-based cohort studies of the European Eye Epidemiology (E3) consortium. Participants: A total of 143240 participants were included in the glaucoma analyses and 47177 participants in the IOP analyses. Methods: We examined associations of four categories of systemic medications (antihypertensive medications: beta-blockers, diuretics, calcium channel blockers [CCBs], alpha-agonists, angiotensin-converting-enzyme inhibitors, angiotensin II receptor blockers; lipid-lowering medications; antidepressants; antidiabetic medications) with glaucoma prevalence and IOP. Glaucoma ascertainment and IOP measurement method were according to individual study protocols. Multivariable regression analyses were carried out in each study and results were pooled using random effects meta-analyses. Associations with antidiabetic medications were examined in diabetic participants only. Main Outcome Measures: Glaucoma prevalence and IOP. Results: In the meta-analyses of our maximally-adjusted multivariable models, use of CCBs was associated with a higher prevalence of glaucoma (odds ratio [OR] with corresponding 95% confidence interval [95% CI]: 1.23 [1.08 to 1.39]). This association was stronger for monotherapy of CCBs with direct cardiac effects (OR [95% CI]: 1.96 [1.23 to 3.12]). The use of other antihypertensive medications, lipid-lowering medications, antidepressants or antidiabetic medications were not clearly associated with glaucoma. Use of systemic beta-blockers was associated with a lower IOP (Beta [95% CI]: -0.33 [-0.57 to -0.08] mmHg). Monotherapy of both selective (Beta [95% CI]: -0.45 [-0.74 to -0.16] mmHg) and non-selective (Beta [95% CI]: -0.54 [-0.94 to -0.15] mmHg) systemic beta-blockers was associated with lower IOP. There was a suggestive association between use of high-ceiling diuretics and lower IOP (Beta [95% CI]: -0.30 [-0.47; -0.14] mmHg), but not when used as monotherapy. Use of other antihypertensive medications, lipid-lowering medications, antidepressants, or antidiabetic medications were not associated with IOP. Conclusions: We identified a potentially harmful association between use of CCBs and glaucoma prevalence. Additionally, we observed and quantified the association of lower IOP with systemic beta-blocker use. Both findings are potentially important given that glaucoma patients frequently use systemic antihypertensive medications. Determining whether the CCB association is causal should be a research priority. published

Type 1 diabetes is a chronic disease that can lead to vision loss when diabetic retinopathy develops. Retinal microvascular alterations occur before the appearance of clinical signs on a fundus examination. This study aimed to analyze retinal vascular parameters on optical coherence tomography angiography (OCT-A) in patients with type 1 diabetes without diabetic retinopathy in comparison with non-diabetic volunteers. This cross-sectional study was conducted at Dijon University Hospital from 2018 to 2020. Vascular densities were measured using macular OCT-A. In total, 98 diabetes patients and 71 non-diabetic volunteers were enrolled. A statistically significant lower vascular density of the inner circle was found in the superficial capillary plexus (SCP) in the diabetes group (p < 0.01). There was a statistically significant correlation between central vascular density in the deep capillary plexus (DCP) and total daily insulin intake (p = 0.042); furthermore, use of the FreeStyle Libre (FSL) device was associated with higher vascular densities in both the SCP (p = 0.034 for outer circle density) and DCP (p < 0.01 for inner circle density and p = 0.023 for outer circle density). Retinal microvascularization was early-altered in type 1 diabetes, and using the FSL device seemed to preserve retinal microvascularization.

Background Incomplete vascularization of the retina in preterm infants carries a risk of retinopathy of prematurity (ROP). Progress in neonatal resuscitation in developing countries has led to the survival of an increasing number of premature infants, resulting in an increased rate of ROP and consequently in visual disability. Strategies to reduce ROP involve optimizing oxygen saturation, nutrition, and normalizing factors such as insulin-like growth factor 1 and n-3 long-chain polyunsaturated fatty acids (LC-PUFA). Our previous study, OmegaROP, showed that there is an accumulation or retention of docosahexaenoic acid (DHA) in mothers of infants developing ROP, suggesting abnormalities in the LC-PUFA placental transfer via fatty acid transporting proteins. The present study aims to better understand the LC-PUFA transport dysfunction in the fetoplacental unit during pregnancy and to find a novel target for the prevention of ROP development. Methods The study protocol is designed to evaluate the correlation between the expression level of placental fatty acid receptors and ROP occurrence. This ongoing study will include 100 patients: patients giving birth before 29 weeks of gestational age (GA) and patients with full-term pregnancies. Recruitment is planned for over 46 months. Maternal and cord blood samples as well as placental tissue samples will be taken following delivery. ROP screening will be performed using wide-field camera imaging according to the International Classification of ROP consensus statement. Discussion The results of this study will have a tangible impact on public health. Indeed, if we show a correlation between the expression level of placental omega-3 receptors and the occurrence of ROP, it would be an essential step in discovering novel pathophysiological mechanisms involved in this retinopathy. Trial registration: 2020-A03253-36

International audience; BACKGROUND: Cardiovascular risk is increased in giant cell arteritis (GCA). We aimed to characterize myocardial infarction (MI) in a GCA cohort, and to compare the GCA and non-GCA population affected by MI. METHODS: In patients with a biopsy-proven diagnosis of GCA between 1 January 2001 and 31 December 2016 in Côte D'Or (France), we identified patients with MI by crossing data from the territorial myocardial infarction registry (Observatoire des Infarctus de Côte d'Or) database. Five controls (non-GCA + MI) were paired with one case (GCA + MI) after matching for age, sex, cardiovascular risk factors and prior cardiovascular disease. MI were characterized as type 1 MI (T1MI), resulting from thrombus formation due to atherothrombotic disease, or type 2 MI (T2MI), due to a myocardial supply/demand mismatch. GCA-related MI was defined as MI occurring within 3 months of a GCA flare (before or after). RESULTS: Among 251 biopsy-proven GCA patients, 13 MI cases were identified and paired with 65 controls. MI was GCA-related in 6/13 cases, accounting for 2.4% (6/251) of our cohort. T2MI was more frequently GCA-related than GCA-unrelated (80% vs. 16.7%, p = 0.080), and GCA diagnosis was the only identified triggering factor in 75% of GCA-related T2MI. GCA-unrelated MI were more frequently T1MI and occurred in patients who had received a higher cumulative dose of prednisone (p = 0.032). GCA was not associated with poorer one-year survival. CONCLUSIONS: GCA-related MI are mainly T2MI probably caused by systemic inflammation rather than coronaritis. GCA-unrelated MI are predominantly T1MI associated with atherothrombotic coronary artery disease.

Introduction: The aim of the study was to estimate the phenotype of retinal vessels using central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), tortuosity, and fractal analysis in the unaffected contralateral eye of patients with central or branch retinal vein occlusion (CRVO or BRVO). Methods: Thirty-four patients suffering from CRVO, 15 suffering from BRVO, and 49 controlled matched subjects had a fundus image analyzed using the VAMPIRE software. The intraclass correlation coefficient and a Bland-Altman plot were done for the reproducibility study. Results: There was a lack of evidence of difference between the control group and the CRVO group for CRAE (p = 0.06), CRVE (p = 0.3), and arterio-venule ratio (AVR, p = 0.6). Contralateral eyes of CRVO exhibited a significantly higher arterial and minimum arterial tortuosity values (p = 0.012), as compared with control eyes. Contralateral eyes of patients with a history of BRVO had a significantly higher CRAE (p = 0.02), AVR (p = 0.006), and minimal arterial tortuosity (p = 0.05). Fractal analysis showed that contralateral eyes of BRVO had higher values of fractal parameters (D0a, p = 0.005). Conclusion: This study suggests that CVRO or BRVO is not triggered by the same retinal vascular phenotypes in the contralateral eye. The morphology of retinal vasculature may be associated with the occurrence of RVO, independently of known risk factors.

International audience; We aimed to compare retinal vascular density in optical coherence tomography Angiography (oct-A) between patients hospitalized for acute coronary syndrome (AcS) and control patients and to investigate correlation with angiogenesis biomarkers. patients hospitalized for an acute coronary syndrome (AcS) in the intensive care Unit were included in the "high cardiovascular risk" group while patients without cardiovascular risk presenting in the ophthalmology department were included as "control". Both groups had blood sampling and OCT-A imaging. Retina microvascularization density in the superficial capillary plexus was measured on 3 × 3 mm angiograms centered on the macula. Angiopoietin-2, TGF-β1, osteoprotegerin, GDF-15 and ST-2 were explored with ELISA or multiplex method. Overall, 62 eyes of ACS patients and 42 eyes of controls were included. ACS patients had significantly lower inner vessel length density than control patients (p = 0.004). A ROC curve found that an inner vessel length density threshold below 20.05 mm −1 was moderately associated with AcS. Significant correlation was found between serum levels of angiopoietin-2 and osteoprotegerin, and retinal microvascularization in OCT-A (R = − 0.293, p = 0.003; R = − 0.310, p = 0.001). Lower inner vessel length density measured with oct-A was associated with AcS event and was also correlated with higher concentrations of angiopoietin-2 and osteoprotegerin. In spite of the improvements in diagnosis and treatment of cardiovascular diseases (CVD), aging of population and urbanization make CVD one of the world's major disease burdens 1,2. Indeed, CVD remain a main cause of premature deaths and disability worldwide, with an estimated 16.7 million deaths in 2010, and projections show an overwhelming 23.3 million by 2030 3. Cardiovascular risk factors such as hypertension, hypercholesterolemia, and diabetes mellitus lead to systemic inflammation, vascular and cardiac oxidative stress, which contribute to coronary dysfunction and microvascular impairment 4. Thus, coronary macro and microvascular alterations are closely associated and together contribute to the pathophysiology of myocardial ischemia 5. The assessment of myocardial microvascularization is then of major interest in order to estimate the risk of acute coronary events; however, only invasive procedures, using intra vascular contrast agents, are currently available 6 .

AimsTo evaluate the accuracy of the ISNT rule (I=inferior, S=superior, N=nasal, T=temporal) and its variants with neuroretinal rim width and retinal nerve fibre layer (RNFL) thickness measurements differentiating normal from glaucomatous eyes.MethodsThe diagnosis accuracy of the ISNT rule and its variants was evaluated in a population-based study. Neuroretinal rim widths were measured on monoscopic optic disc photographs with an image-processing program. RNFL thickness measurements were obtained with spectral-domain optical coherence tomography (SD-OCT).ResultsIn this study including 940 normal subjects and 93 patients with glaucoma, the sensitivity of the ISNT rule with optic disc photographs was 94.1% (95% CI 90.2 to 98.1), whereas its specificity was 49.2% (46.9 to 51.6). When using the IST rule, the sensitivity decreased to 69.9% (62.1 to 77.6) with a higher specificity, 87.0% (85.3 to 88.6). All the diagnosis indicators were somewhat lower for the different rules using RNFL thickness: the sensitivity of the ISNT rule was 79.4% (72.6 to 86.2) and its specificity was 34.1% (31.9 to 36.4). With the IST rule, the sensitivity decreased to 50.0% (41.6 to 58.4) while the specificity increased to 64.9% (62.7 to 67.2).ConclusionsThe ISNT and IST rules applied to neuroretinal rim width measurement by optic disc photographs are useful and simple tools for differentiating normal from glaucomatous eyes. The translation of these rules to RNFL thickness by SD-OCT is of limited value.

The main purpose of the study was to report the estimated incidence, cumulative rate, risk factors and outcomes of submacular haemorrhage (SMH) with loss of vision in neovascular age-related macular degeneration (nAMD) receiving intravitreal injections (IVT) of vascular endothelial growth factor (VEGF) inhibitor in routine clinical practice.Retrospective analysis of treatment-naïve eyes receiving IVTs of VEGF inhibitors (ranibizumab, aflibercept or bevacizumab) for nAMD from 1 January 2010 to 31 December 2020 that were tracked the Fight Retinal Blindness! registry. Estimated incidence, cumulative rate and hazard ratios (HR) of SMH with loss of vision during treatment were measured using the Poisson regression, Kaplan-Meier survival curves and Cox proportional hazard models.We identified 7642 eyes (6425 patients) with a total of 135 095 IVT over a 10-year period. One hundred five eyes developed SMH with loss of vision with a rate of 1 per 1283 injections (0.08% 95% confidence interval [95% CI] [0.06; 0.09]). The estimated incidence [95% CI] was 4.6 [3.8; 5.7] SMH with loss of vision per year per 1000 treated patients during the study. The cumulative [95% CI] rate of SMH per patient did not increase significantly with each successive injection (p = 0.947). SMH cases had a mean VA drop of around 6 lines at diagnosis, which then improved moderately to a 4-line loss at 1 year.Submacular haemorrhage (SMH) with loss of vision is an uncommon complication that can occur at any time in eyes treated for nAMD in routine clinical practice, with only limited recovery of vision 1 year later.

The effect of intraocular injections of anti-vascular endothelial growth factor (VEGF) on intraocular pressure (IOP) has not been clearly stated. We extracted data from the electronic health records at Dijon University Hospital of 750 patients who were unilaterally injected with anti-VEGF agents between March 2012 and March 2020. These were treatment-naïve patients who had received at least three injections of the same treatment (aflibercept, bevacizumab, or ranibizumab) in one eye only, and had IOP measurements before and after the injections. Fellow untreated eyes were used as comparators. A clinically significant IOP rise was determined as an IOP above 21 mmHg and an increase of at least 6 mmHg compared to baseline, or the need for IOP-lowering agents. We found an overall slight increase in IOP between treated and untreated eyes at 6 months (+0.67 ± 3.33 mmHg, 95% confidence interval 0.33–1.02, p < 0.001). Ranibizumab had a higher final IOP at 1 and 3 months. Age, sex, and the number of injections were not associated with IOP variation. Ranibizumab was associated with a higher rate of increase in clinically significant IOP at 6 months (p = 0.03). Our study confirms that anti-VEGF injections constitute a relatively safe treatment regarding their impact on IOP.

We analyzed the results of mobile screening for diabetic retinopathy (DR) using retinal photographs, comparing these results between rural and periurban areas, and before and after the first national COVID-19 pandemic lockdown. The Burgundy Union Régionale des Professionnels de Santé (URPS) has organized an annual DR screening since 2004. The examination, performed by an orthoptist, consisted of taking the patient′s history, intraocular pressure measurement, and taking retinal photographs. After remote transmission, the examinations were interpreted by participating ophthalmologists at the Dijon University Hospital. In September 2016, the screening was open to periurban townships. In 11 years, 10,220 patients were screened: 1420 patients (13.9%) had DR of any type, with an average age of 68.5 (±11.3) years, and 59.2% were men. These patients had a statistically significantly higher glycated hemoglobin level (7.4% vs. 7.0%) and a longer duration of diabetes (13.8 vs. 9.3 years) than patients without DR. When comparing rural and periurban areas and periods before and after the beginning of the COVID-19 pandemic, we did not find any significant difference in the screening results. The results of this study are in line with the average findings of similar studies comparing screening strategies for DR. The early detection of DR can benefit from mobile telemedicine screening, identifying a considerable number of patients at an elevated risk, especially in rural areas where access to ophthalmological care is limited.

Objectives An increased risk of haematological malignancies (HM) has been reported in GCA patients. Our study aimed to investigate the incidence and the type of HM occurring in GCA. Methods All patients with GCA and HM living in Côte d’Or (France) were identified by crossing data from the RHEMCO (Registre des Hémopathies Malignes de Côte d’Or) and those having a positive temporal artery biopsy between 1 January 2001 and 31 December 2018. Results Among 276 biopsy-proven GCA patients, 14 HM were identified in 12 patients (4.3%). In comparison with the general population aged >50 y, the incidence of myeloid HM and myeloproliferative syndromes were increased in GCA patients [standardized incidence ratios (SIR) = 2.71 and 5.16, respectively], with a specific increase in men with GCA (SIR = 4.82 and 9.04, respectively) but not in women. In addition, the study of SIR depending on the chronology between GCA and HM diagnoses suggests that there was an increased risk of developing GCA in men but not in women, after a diagnosis of myeloid HM (SIR = 9.56), especially if it was a MPS (SIR = 17.56). Conclusions Our study shows a particular epidemiology of HM in GCA patients, which is characterized by an increased incidence of myeloid HM, especially MPS, in male GCA patients. The chronology of the diagnoses of GCA and HM raises the hypothesis that clonal hematopoiesis may be implicated in some cases of GCA.

Purpose Assessment of cardiovascular risk is the keystone of prevention in cardiovascular disease. The objective of this pilot study was to estimate the cardiovascular risk score (American Hospital Association [AHA] risk score, Syntax risk, and SCORE risk score) with machine learning (ML) model based on retinal vascular quantitative parameters. Methods We proposed supervised ML algorithm to predict cardiovascular parameters in patients with cardiovascular diseases treated in Dijon University Hospital using quantitative retinal vascular characteristics measured with fundus photography and optical coherence tomography - angiography (OCT-A) scans (alone and combined). To describe retinal microvascular network, we used the Singapore "I" Vessel Assessment (SIVA), which extracts vessel parameters from fundus photography and quantitative OCT-A retinal metrics of superficial retinal capillary plexus. Results The retinal and cardiovascular data of 144 patients were included. This paper presented a high prediction rate of the cardiovascular risk score. By means of the Naive Bayes algorithm and SIVA + OCT-A data, the AHA risk score was predicted with 81.25% accuracy, the SCORE risk with 75.64% accuracy, and the Syntax score with 96.53% of accuracy. Conclusions Performance of these algorithms demonstrated in this preliminary study that ML algorithms applied to quantitative retinal vascular parameters with SIVA software and OCT-A were able to predict cardiovascular scores with a robust rate. Quantitative retinal vascular biomarkers with the ML strategy might provide valuable data to implement predictive model for cardiovascular parameters. Translational relevance Small data set of quantitative retinal vascular parameters with fundus and with OCT-A can be used with ML learning to predict cardiovascular parameters.

International audience; Purpose: Artificial intelligence (AI) has entered the field of medicine, and ophthalmology is no exception. The objective of this study was to report on scientific production and publication trends, to identify journals, countries, international collaborations, and major MeSH terms involved in AI in ophthalmology research.Methods: Scientometric methods were used to evaluate global scientific production and development trends in AI in ophthalmology using PubMed and the Web of Science Core Collection.Results: A total of 1356 articles were retrieved over the period 1966-2019. The yearly growth of AI in ophthalmology publications has been 18.89% over the last ten years, indicating that AI in ophthalmology is a very attractive topic in science. Analysis of the most productive journals showed that most were specialized in computer and medical systems. No journal was found to specialize in AI in ophthalmology. The USA, China, and the UK were the three most productive countries. The study of international collaboration showed that, besides the USA, researchers tended to collaborate with peers from neighboring countries. Among the twenty most frequent MeSH terms retrieved, there were only four related to clinical topics, revealing the retina and glaucoma as the most frequently encountered subjects of interest in AI in ophthalmology. Analysis of the top ten Journal Citation Reports categories of journals and MeSH terms for articles confirmed that AI in ophthalmology research is mainly focused on engineering and computing and is mainly technical research related to computer methods.Conclusions: This study provides a broad view of the current status and trends in AI in ophthalmology research and shows that AI in ophthalmology research is an attractive topic focusing on retinal diseases and glaucoma. This study may be useful for researchers in AI in ophthalmology such as clinicians, but also for scientists to better understand this research topic, know the main actors in this field (including journals and countries), and have a general overview of this research theme.

The purpose of this study was to report a case of recurrent conjunctival erosion and XEN Gel Stent exposure after implantation in a primary open-angle glaucoma patient. Minimally invasive glaucoma surgery (MIGS) is a new approach in glaucoma surgery, and there is a lack of published data with regard to the management of postoperative ocular surface complications.This is a case report of a patient with a persistent corneal erosion after XEN Gel Stent implantation. A standalone MIGS surgery was planned for both eyes in this case of refractory glaucoma. Despite a first surgical revision, the patient was suffering from a chronic leaking bleb, an exposed XEN Gel Stent, and severe hypotonia in the left eye.A free conjunctival autografting technique covered with a complementary amniotic membrane graft was performed under local anesthesia. One month following bleb revision, the intraocular pressure was 13 mm Hg on medical treatment, and slit-lamp examination showed a well-formed moderate bleb with no leakage.This is the first described case of the use of a free conjunctival autograft to treat a persistently leaking bleb after XEN Gel Stent implantation. This case highlights the potential complication of conjunctival erosion due to XEN Gel Stent implantation. It emphasizes the management of complicated filtration blebs after MIGS surgery.

(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.

Background To compare plasma fatty acids (FAs) between participants with primary open-angle glaucoma (POAG) and participants without neuropathy in an elderly population and to investigate specific FAs pattern in POAG. Methods We conducted a population-based study in participants older than 75 years. Participants underwent a comprehensive eye examination with optic nerve photographs, visual field test and optic nerve OCT with RNFL thickness measurement. Glaucomatous status was defined according to the International Society for Epidemiologic and Geographical Ophthalmology classification. Lipids were extracted from plasma and FAs methylesters prepared and analyzed by gas chromatography-mass spectrometry. Results Among the 1153 participants of the Montrachet study 810 were retained for analysis and 68 had POAG. The mean age was 82.11 ± 3.67. In multivariable analysis FAs levels were not different between POAG participants and controls (P = 0.078). A FAs pattern characterized by high negative weight of gamma-linoleic acid, eicosapentaenoic acid polyunsaturated FAs (PUFAs), Cis-7 hexadecenoic acid monounsaturated FAs (MUFAs) and high positive weight of eicosadienoic acid, docosatetraenoic acid, docosapentaenoic n-6, alpha linoleic acid PUFAs, eicosenoic acid MUFAs, margaric acid and behenic acid saturated FAs was positively associated with POAG. After adjustment for major confounders, individuals in the upper tertile of FAs pattern scores compared with those in the lower tertile were more likely to present POAG (OR = 3.09 [95% CI 1.29–7.40] P = 0.013). Conclusions We found no significant difference regarding isolated plasma FAs between participants with POAG and participants without neuropathy in elderly but specific FAs pattern might be associated with POAG.

Background: To evaluate the repeatability and reproducibility of the retinal vascular network fractal dimension (FD) measured from swept-source optical coherence tomography angiography (SS-OCTA) images of healthy eyes. Methods: A cross-sectional study was undertaken with young healthy volunteers who had no reported cardiac risk factors or ocular disease history. For each participant, three SS-OCTA images (12×12 mm) were acquired using the Cirrus Plex Elite 9000 (Carl Zeiss Meditec AG, Jena, Germany) by two ophthalmologists. The data from one eye per participant were retained for analysis. Automated segmentation was obtained from both the superficial and deep capillary plexuses. Fractal box-counting analyses were performed. The intraclass correlation coefficients (ICC) and the coefficient of variation (CV) were used as measures for repeatability and reproducibility. Results: A total of 43 eyes of healthy volunteers were included. The mean ± standard deviation (SD) age was 30 ± 6.2 years. The mean retinal vascular network FD was 1.693 in the superficial and 1.694 in the deep vascular layer in our healthy cohort. For repeatability, the ICC was 0.722 (95% CI, 0.541–0.839) in the superficial capillary plexus and 0.828 (95% CI, 0.705–0.903) in the deep capillary plexus. For reproducibility, the ICC was 0.651 (95% CI, 0.439–0.795) and 0.363 (95% CI, 0.073–0.596) at the superficial and deep capillary plexus, respectively. The CV for each observer was less than 5% in the two plexuses.Conclusions: In this study, the retinal vascular network FD provided new repeatability and reproducibility quantitative data using SS-OCTA with healthy participants.

International audience; OBJECTIVES: To assess the quality-of-life improvement after scleral lens fitting in patients with keratoconus. METHODS: We conducted a prospective observational study of all consecutive patients with keratoconus starting scleral lens fitting in 2019, from January 2 to December 27, at the Dijon University Hospital, France. Quality of life was assessed before and after wearing scleral lenses for 3 months through the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ 25) questionnaire. We investigated factors potentially influencing quality of life: final visual acuity, keratoconus stage, and maximum keratometry reading. RESULTS: In total, 41 eyes of 24 patients were successfully fitted with scleral lenses, 92.9% were 18 mm in diameter and 7.1% were 17 mm. The visual acuity improved by -0.4±0.3 logarithm of the minimum angle of resolution (P

International audience; Purpose 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.

(1) Background: To compare macular pigment optical density (MPOD) and its spatial distribution between eyes with primary open-angle glaucoma (POAG) and control eyes in an elderly population. (2) Methods: The Montrachet study (Maculopathy Optic Nerve and nutrition neurovAsCular and HEarT) is a population-based study including participants aged 75 years and over. All participants had a slit lamp examination, fundus photographs, and a questionnaire about their medical past history and smoking status. Optic disc spectral domain optical coherence tomography was also performed. All glaucoma-suspected patients were convocated to have a new full examination. We only retained one eye with POAG for analysis in the glaucoma group and one eye without optic neuropathy in the control participants group. MPOD measurements were performed with the two-wavelength autofluorescence method (488 and 514 nm). (3) Results: Overall, 601 eyes had MPOD measurements among 1153 participants. Among the 601 eyes, 48 had POAG. The mean age for the glaucoma and control participants was 84.01 ± 4.22 years and 81.94 ± 3.61 years, respectively (p < 0.001). In the multivariable analysis, we could not find any association between POAG and MPOD at 0.5° (p = 0.336). We found no significant difference regarding MP spatial distribution between the two groups (p = 0.408). (4) Conclusion: In this elderly population-based study, eyes with POAG and control eyes without optic neuropathy did not differ in terms of MPOD and MP spatial distribution.

PurposeTo investigate the association between the characteristics of the retinal vascular network in the elderly and retinal nerve fiber layer (RNFL) thickness in a population-based study.MethodsWe conducted a population-based study, the Montrachet study (Maculopathy Optic Nerve, nuTRition neurovAsCular, and HEarT disease), in participants aged ≥ 75 years. RNFL thickness was assessed with spectral-domain optical coherence tomography (SD-OCT). Analysis of the retinal vascular network was performed by means of the Singapore "I" Vessel Assessment (SIVA) software based on fundus photography.ResultsData from 970 participants were suitable for analysis. Patients with optic neuropathy were excluded. In multivariable analysis, each standard deviation (SD) decrease in the caliber of the six largest arterioles and veins in zone B and the six largest arterioles and veins in zone C was associated with a decrease in global RNFL thickness (β = -1.62 μm, P = 0.001; β = -2.39 μm, P < 0.001; β = -1.56 μm, P = 0.002; and β = -2.64 μm, P < 0.001, respectively).ConclusionsOur study found that decreased retinal vessels caliber were associated with a decreased RNFL thickness in the elderly without optic neuropathy.

International audience; PURPOSE: To characterize the phenotype of retinal vessels using central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), tortuosity and fractal dimension (FD) in primary open-angle glaucoma (POAG) subjects. METHODS: This prospective case-control multicentre study included 61 POAG subjects and 61 controls matched for age, systemic hypertension and body mass index. Fundus images of the right eye were acquired using a non-mydriatic camera. Central retinal artery equivalent (CRAE), CRVE, arteriole-to-venule ratio, FD and tortuosity of the vascular network were measured using VAMPIRE software (Vessel Assessment and Measurement Platform for Images of the Retina). Primary open-angle glaucoma (POAG) patients underwent 24.2 sita-standard visual field and peri-papillary optical coherence tomography (OCT) examinations. Data were expressed as median and interquartile range (75-25th percentiles). RESULTS: The control group was comparable to the POAG group for sex ratio, refraction and intraocular pressure. The mean CRAE and the mean CRVE were significantly lower in the POAG group than in the control group [150.5 (137.9; 157.1) mum versus 161.3 (154.0; 168.4) mum and 204.8 (190.1; 218.1) mum versus 233.5 (222.3; 246.9) mum, respectively; p < 0.001] and for fractal parameters as well. No significant difference was found for tortuosity between the two groups. There was a significant correlation between CRAE and retinal nerve fibre layer (RNFL) thickness (r = 0.27; p = 0.03). VAMPIRE parameters were not correlated with visual field indices. CONCLUSION: Primary open-angle glaucoma (POAG) was associated with a narrowing of arterial and venous retinal vessels, a higher arteriole-to-venule ratio and lower values of FD. The relationship between CRAE and RNFL thickness needs further investigation.

INTRODUCTION: Quantitative measurements of retinal microvasculature by optical coherence tomography angiography (OCT-A) have been used to assess cardiovascular risk profile. However, to date, there are no studies focusing on OCT-A imaging in the setting of the altered hemodynamic status found in high-risk cardiovascular patients. METHODS: To determine the potential association between retinal vascular density on OCT-A and a comprehensive battery of hemodynamic variables in patients with myocardial infarction (MI) using data from the acute phase and at 3 months follow-up after cardiac rehabilitation. This prospective longitudinal study included patients who presented with MI in the cardiology intensive care unit at Dijon University Hospital. Main outcomes and measurements were retinal vessel density on OCT-A, hemodynamic status based on left ventricular ejection fraction (LVEF), and indexed cardiac output during the acute phase of myocardial infarction and at 3 months follow-up. RESULTS: Overall, 30 patients were included in this pilot study. The median (IQR) age was 64 years (55-71) with 87% men. At admission, the mean (SD) LVEF was 53% (11), and the mean indexed cardiac output was 2.70 (0.83) L/min/m(2). On OCT-A, the mean inner retinal vascular density was 19.09 (2.80) mm(-1). No significant association was found between retinal vascular density and hemodynamic variables. CONCLUSION: We found no significant association between retinal vascular density on OCT-A and hemodynamic variables in the acute phase of a myocardial infarction or after 3 months of cardiac rehabilitation. Therefore, OCT-A findings do not seem to be influenced by the hemodynamic changes associated with myocardial infarction., Introduction : Les caractéristiques quantitatives de la microvascularisation rétinienne en tomographie par cohérence optique angiographie (OCT-A) ont été utilisées pour évaluer le profil de risque cardiovasculaire. Cependant à ce jour, aucune étude ne s’est intéressée à la description microvasculaire en OCT-A dans un contexte d’une altération de l’état hémodynamique chez des patients présentant un risque cardiovasculaire élevé. Méthodes : Déterminer l’association potentielle entre la densité vasculaire rétinienne en OCT-A et un ensemble exhaustif de variables hémodynamiques chez des patients atteints d’un infarctus du myocarde en utilisant les données de la phase aiguë et du suivi à 3 mois, après une rééducation cardiaque. Cette étude longitudinale prospective a inclus des patients présentant un infarctus du myocarde dans l’unité de soins intensifs cardiologique du centre hospitalier universitaire de Dijon. Les critères principaux étaient la densité vasculaire rétinienne en OCT-A, la fraction d’éjection ventriculaire gauche (FEVG) et le débit cardiaque indexé à la phase aiguë de l’infarctus du myocarde et lors du suivi à 3 mois. Résultats : Au total, 30 patients ont été inclus dans cette étude pilote. L’âge médian (écart interquartile) était de 64 ans (55–71) avec 87 % d’hommes. À l’admission, la FEVG moyenne (écart type) était de 53 % (11) et le débit cardiaque indexé moyen était de 2,70 (0,83) L/min/m2. De plus, la densité vasculaire rétinienne interne moyenne était de 19,09 (2,80) mm−1. Aucune association significative n’a été trouvée entre la densité vasculaire rétinienne et les variables hémodynamiques. Conclusion : Nous n’avons pas trouvé d’association significative entre la densité vasculaire rétinienne en OCT-A et les variables hémodynamiques ni à la phase aiguë de l’infarctus du myocarde ni après 3 mois de réadaptation cardiaque. Par conséquent, les résultats quantitatifs de l’OCT-A ne semblent pas être influencés par les variations hémodynamiques chez des patients ayant présenté un infarctus du myocarde.

Introduction L’arterite a cellules geantes (ACG) est une vascularite granulomateuse affectant les arteres de gros calibres dont le diagnostic repose sur l’association de signes cliniques et d’une preuve de vascularite apportee par la biopsie d’artere temporale (BAT) et/ou les donnees de l’imagerie. Les cellules musculaires lisses (CML) presentes dans la media jouent un role majeur dans la physiopathologie de cette vascularite. En presence d’interferon-gamma (IFN-γ) produit par les lymphocytes Th1 infiltrant la paroi arterielle, les CML secretent des chimiokines aboutissant au recrutement de lymphocytes T (LT) et de monocytes dans la paroi vasculaire. L’objectif de notre travail etait d’etudier les interactions entre CML, myofibroblastes (MF) et LT au sein des arteres de patients atteints d’ACG. Materiels et methodes Depuis novembre 2017, un fragment des BAT realisees dans notre centre etait envoye au laboratoire le jour meme a l’etat frais. Le phenotype des cellules de la paroi vasculaire etait analyse par microscopie confocale (microscope Leica TCS SP8). Des fragments de BAT negatives ont ete mis en culture ex vivo dans une matrice (MATRIGEL) afin de generer des cellules vasculaires qui ont ete analysees par immunofluorescence, cytometrie en flux et RT-PCR. [1] Leur proliferation a ete evaluee par impedancemetrie (iCELLigence system). Ces cellules vasculaires ont ete traitees ou non par IFN-γ (100 ng/mL) et TNF-α (40 ng/mL) ou interleukine-6 (IL-6) (10 ng/mL) et recepteur soluble de l’IL-6 (IL-6Rs) (100 ng/mL) pendant 72 heures puis cultivees seules ou en presence de cellules mononucleees (PBMC) pendant 7 jours. Les PBMC et les cellules vasculaires ont ensuite ete separees par traitement a l’EDTA et analysees par cytometrie en flux. Le logiciel FlowJo etait utilise l’analyse des donnees de cytometrie en flux. L’expression des ARNm des genes etudies en RT-PCR etait exprimee en unite arbitraire en reference a l’expression du gene GusB. Les resultats etaient exprimes en mediane et P etait le resultat de tests de Wilcoxon. Resultats L’analyse en microscopie confocale des BAT presentant des lesions d’ACG a montre que la neointima hyperplasique etait constituee de MF derivant des CML (d-MF) (α-SMA + Desmin + MHC11lowCD90 + ) dont le phenotype correspondait a celui des cellules obtenues a partir des cultures ex vivo de BAT. A l’inverse des BAT saines, les CML et les d-MF presents dans les BAT atteintes d’ACG, exprimaient HLA-DR, la forme phosphorylee de STAT1 (pSTAT1) et plus moderement pSTAT3, montrant que la voie de signalisation de l’IFN-γ etait activee dans ces cellules. Nous avons reproduit ce type d’activation sur les d-MF cultives in vitro. Lorsque les d–MF etaient prealablement exposes a l’IFN-γ et au TNF-α, leur capacite de proliferation etait diminuee et leur niveau d’expression de HLA-DR et de CD86 augmentait (mediane de fluorescence respectives passant de 57 a 0 [p = 0,03] et de 103 a 34 [p = 0,03]). Exposes a l’IL-6 et l’IL-6Rs, leur capacite de proliferation n’etait pas modifiee et leur niveau d’expression de HLA-DR (MFI = 7,7) et de CD86 (MFI = 67,7) etait significativement plus faible qu’apres traitement par IFN-γ et TNF-α (p = 0,03). La polarisation des LT en Th1 (CD4 + CD8-IFN-γ+) et Tc1 (CD4-CD8 + IFN-γ+) et dans une moindre mesure en Th17 (CD4 + CD8-IL-17 + ) et Tc17 (CD4-CD8 + IL-17 + ) etait augmentee lorsque les PBMC etaient cultivees en presence de d-MF (p ≤ 0,001 et p ≤ 0,05 respectivement). Cet effet sur la polarisation Th1/Tc1 etait augmente lorsque les d-MF avaient prealablement ete exposes a l’IFN-γ et au TNF-α (p = 0,03). Les d-MF exprimaient faiblement le gene IL12p35 a l’etat basal ; son expression augmentait apres exposition a l’IFN-γ et au TNF-α (3,78 vs 32,57, p = 0,03), ce qui est concordant avec l’effet positif des d-MF sur la polarisation Th1. Conclusion Dans les arteres presentant des lesions d’ACG, les cellules constituant la neointima hyperplasique ont un phenotype de d–MF et expriment fortement pSTAT1 ce qui traduit une exposition in vivo a l’IFN-γ. Lorsque ces cellules sont en contact avec des PBMC, elles orientent la polarisation des LT vers la voie Th1/Tc1. Cet effet est encore plus important lorsque les d-MF sont prealablement exposes a un environnement cytokinique de type Th1 (IFN-γ + TNF-α), ce qui n’est pas le cas lorsque ces cellules sont exposees a l’IL-6. Nos resultats suggerent donc que les d-MF jouent un role dans l’amplification de l’inflammation vasculaire de type Th1 au cours de l’ACG.

Introduction L’arterite a cellules geantes (ACG) est une vascularite du sujet âge au cours de laquelle les cellules mononucleees jouent un role physiopathologique majeur. L’hematopoiese clonale est un phenomene dont la frequence augmente egalement avec l’âge et qui conduit a l’apparition de mutations responsables de la survenue d’hemopathies malignes (HM) ou de mutations des cellules effectrices de l’immunite responsables de pathologies inflammatoires. Notre hypothese est qu’il existe une association specifique entre certaines HM et l’ACG. Nous avons pu etudier cette hypothese en croisant les donnees du registre des hemopathies de Cote d’Or (RHEMCO) et celles de tous les laboratoires d’anatomopathologie de Cote d’Or afin de decrire l’epidemiologie des HM au cours de l’ACG. Patients et methodes Tous les patients qui avaient beneficie d’une biopsie d’artere temporale analysee entre le 1er janvier 2001 et le 31 decembre 2018 dans les deux seuls centres d’anatomie et cytologie pathologiques de Cote d’Or et qui montraient des lesions d’ACG ont ete selectionnes. Les diagnostics d’HM qui sont survenues entre le 1er janvier 2001 et le 31 decembre 2018 dans la population atteinte d’ACG ont ete identifies grâce aux donnees du RHEMCO qui recense de facon exhaustive tous les cas d’HM survenant en Cote d’Or. Le diagnostic d’HM etait considere comme synchrone au diagnostic d’ACG s’il survenait dans le mois precedant ou suivant le diagnostic d’ACG. Resultats Parmi les 276 patients chez qui une ACG a ete diagnostiquee pendant la periode etudiee, 14 HM ont ete identifiees chez 12 patients (4,3 %). La frequence des HM myeloides (p = 0,047) et plus specifiquement des syndromes myeloproliferatifs (SMP) presentant la mutation V617F du gene JAK2 (p = 0,012) etait augmentee chez les patients atteints d’ACG par rapport aux patients âges de plus de 50 ans sans ACG. Il y avait egalement une augmentation significative de l’incidence des HM myeloides (rapport standardise d’incidence [RSI] = 4,82), avec une augmentation specifique de l’incidence des SMP JAK2 mutes (RSI = 9,04) chez les hommes atteints d’ACG, mais pas chez les femmes. De plus, l’etude du RSI en fonction de la chronologie entre les diagnostics d’ACG et d’HM a montre qu’il existait un risque accru de developper une ACG apres un diagnostic d’HM (SIR = 4,59) et surtout apres un diagnostic d’HM myeloide (RSI = 9,56 et RSI = 17,56 pour les MPS presentant la mutation V617F de JAK2) chez les hommes mais pas chez les femmes. Conclusion Notre etude montre que l’epidemiologie des HM chez les patients atteints d’ACG differe de celle de la population generale. En effet, l’incidence des HM myeloides et plus particulierement des SMP JAK2 mutes, est augmentee chez les hommes atteints d’ACG. Compte tenu du role des proteines JAK dans la signalisation cellulaire dans les cellules mononucleees, ces resultats suggerent une implication de l’hematopoiese clonale au cours de l’ACG et constitue un lien physiopathologique entre vieillissement et ACG.

International audience; Purpose To develop a risk-prediction nomogram based on baseline variables for good functional response during the 1st year of treatment with anti-VEGF agents in naive diabetic macular oedema (DME). Methods This retrospective study included patients presenting naive-DME treated with anti-VEGF therapy at Dijon University Hospital (France) between 1 February 2012 and 31 March 2015 (derivation cohort). We studied baseline variables that had significant associations with a good functional response to anti-VEGF agents during the 1st year of treatment. We used a program to generate a nomogram based on a binary logistic regression predictive model. Then, this nomogram was tested on data from a separate cohort of naive-DME patients from a multicenter study involving 20 French ophthalmologic centres between January 2014 and June 2015 (validation cohort). Results Age, baseline BCVA and ellipsoid zone integrity on spectral-domain optical coherence tomography (SD-OCT) are functional prognostic factors and were used to build a nomogram. The nomogram showed excellent discrimination for good functional responders (area under the curve (AUC) = 0.906, 95% confidence interval (95% CI) = [0.849-0.964], p = 0.004). The discriminative power of this nomogram was tested on the validation cohort data, demonstrating good discrimination of good functional responders (AUC = 0.942, 95% CI = [0.898-0.986], p < 0.001). Conclusion This nomogram provides a useful estimation of a good functional response in naive-DME patients treated with anti-VEGF agents.

International audience; Purpose: The aim of this study was to investigate the prevalence of subretinal drusenoid deposits (SDD) and to identify associated factors in an elderly population. Methods: The participants of the population-based Montrachet study underwent an exhaustive ophthalmologic examination, including color fundus photography and macular spectral domain-optical coherence tomography (SD-OCT), coupled with infrared reflectance imaging. The presence of SDD and other age-related macular degeneration lesions, according to the European Eye Epidemiology SD-OCT classification of macular diseases, and subfoveal choroidal thickness were recorded. Moreover, the association of SDD and both clinical and demographic factors as well as plasma levels of vitamin E and lutein/zeaxanthin (L/Z) were analyzed. Results: The mean age of patients was 82.3 ± 3.8 years and 62.7% were female. The prevalence of SDD was 18.1% (n = 205) in the subjects with at least one eye interpretable (n = 1135). In multivariate analysis, SDD was positively associated with increasing age (OR, 4.6; 95% CI, 2.8–7.7; P < 0.001 for subjects aged >85 years), female sex (OR, 1.7; 95% CI, 1.2–2.4; P = 0.005), and plasma L/Z level (OR, 1.2; 95% CI, 1.0–1.5; P = 0.039), and negatively associated with lipid-lowering drugs use (OR, 0.5; 95% CI, 0.3–0.9; P = 0.014 for statin medications) and subfoveal choroidal thickness (OR, 0.8; 95% CI, 0.7–0.9; P = 0.002). Conclusions: The prevalence of SDD was high in subjects older than 75 years, more frequent in women, and was associated with a thinner choroid. The association with lipid-lowering drugs deserves further investigation.

International audience; Purpose: To measure subfoveal choroidal thickness (SFCT) in the elderly and to determine the associations among SFCT, cardiovascular history, and the 10-year risk of fatal cardiovascular disease (CVD). Methods: We conducted a population-based study, the Montrachet (Maculopathy Optic Nerve, nuTRition neurovAsCular, and HEarT disease) study, in subjects older than 75 years. SFCT was measured with spectral-domain optical coherence tomography (SD-OCT) with enhanced-depth mode imaging. Participants underwent a comprehensive eye examination. The history of CVD, CVD risk factors, and a score-based estimation of their 10-year risk of cardiovascular mortality (Heart Score) were collected. Results: Overall, 764 participants were retained for analysis. The mean SFCT was 206.4 +/- 83.0 mum. The mean age was 81.9 +/- 3.6 years. After a multivariable analysis, older age (beta = -32.56 mum, P < 0.001) and longer axial length (beta = -20.71 mum, P < 0.001) were independently associated with thinner SFCT. SFCT was not significantly associated with sex, cardiovascular history, classical CVD risk factors, or prognostic risk score. Conclusions: This study confirms that longer axial length and older age are associated with thinner SFCT. However, SFCT does not appear to be a biomarker for cardiovascular history in this study.

Introduction Le risque d’evenement cardiovasculaire est accru au cours de l’arterite a cellules geantes (ACG), en particulier dans les premiers mois suivant le diagnostic de la vascularite [1] . L’objectif de ce travail etait de decrire les caracteristiques des infarctus du myocarde (IDM) survenant chez des patients atteints d’ACG et de les comparer avec des IDM survenant chez des patients ne presentant pas d’ACG au moment de leur IDM. Patients et methodes Les patients atteints d’ACG ont ete identifies parmi la liste des biopsies d’artere temporale (BAT) qui montraient des lesions d’ACG et qui avaient ete analysees entre le 1er janvier 2001 et le 31 decembre 2016 dans les deux laboratoires d’anatomie et cytologie pathologiques de notre departement. Les diagnostics d’IDM survenus entre le 1er janvier 2001 et le 3 septembre 2019 dans la population atteinte d’ACG (cas) ont ete identifies dans la base de donnees RICO (obseRvatoire des Infarctus de Cote d’Or). Chaque cas a ete compare a 5 temoins sans ACG et presentant un IDM dans la meme periode d’etude, apres appariement sur l’âge, le sexe, les facteurs de risque cardiovasculaire et les antecedents de maladies cardiovasculaires. L’IDM etait de type 1 s’il etait cause par une maladie coronarienne atherothrombotique responsable d’un thrombus intraluminal, ou de type 2 s’il etait lie a un desequilibre entre besoins et apport en oxygene au myocarde et qu’il n’y avait pas d’argument pour un IDM de type 1. L’IDM etait considere en lien avec l’ACG s’il etait diagnostique dans les 3 mois precedant ou suivant une poussee d’ACG. Resultats Parmi les 251 patients presentant une ACG a BAT positive pendant la periode etudiee, 13 ont presente un IDM, dont 6 (2,4 %) etaient en lien avec une poussee d’ACG. Ces 13 cas ont ete compares a 65 temoins. Les IDM en lien avec une poussee d’ACG survenaient le plus souvent au moment du diagnostic d’ACG, avec un delai median de 25 jours Ces IDM etaient majoritairement de type 2 contrairement aux IDM sans lien avec l’ACG (80 % vs 16,7 %, p = 0,080) et la vascularite a eteconsideree comme le seul facteur declenchant pour 75 % des IDM de type 2 lies a l’ACG. Les patients presentant un IDM en lien avec une poussee d’ACG etaient plus jeunes (p = 0,005), n’avaient pas d’antecedent de pathologie cardiovasculaire (p = 0,070) et avaient une atteinte coronarienne monotronculaire (p = 0,034). Les IDM non lies a une poussee d’ACG survenaient plusieurs annees apres le diagnostic d’ACG (delai median = 6,5 ans ), chez des patients plus âges ayant une coronaropathie etendue (100 % des cas) et des antecedents de maladies cardiovasculaires (57 % des cas). Ces patients avaient recu une dose cumulee de prednisone plus elevee (5,1 vs 4,2 g a 6 mois [p = 0,048] et 7,4 vs 5,7 g a 12 mois du diagnostic d’ACG [p = 0,032]). Les analyses multivariees ont montre que l’ACG n’etait pas associee a une diminution de la survie 1 an apres l’IDM. Conclusion Notre etude apporte une description precise des caracteristiques des IDM survenant chez les patients atteints d’ACG. L’IDM en lien avec l’ACG est un evenement rare dont les caracteristiques sont singulieres. Il s’agit generalement d’IDM de type 2 favorises par l’importante inflammation systemique qui caracterise cette vascularite. Par ailleurs, la corticotherapie au long cours semble jouer un role favorisant dans la survenue d’IDM non lies a une poussee d’ACG, plus tardifs et de mecanisme atheromateux.

Correspondance to: catherine.creuzot-garcher@chu-dijon.fr, Department of Ophthalmology, University Hospital, Dijon, France, Eye and Nutrition Research group, CSGA, UMR 1324 INRA, Dijon, France.; International audience; PurposeTo identify patterns summarizing the retinal vascular network in the elderly and to investigate the relationship of these vascular patterns with cardiovascular history.MethodsWe conducted a population-based study, the Montrachet study (Maculopathy Optic Nerve nuTRition neurovAsCular and HEarT diseases), in participants older than 75 years. The history of cardiovascular disease and a score-based estimation of their 10-year risk of cardiovascular mortality (Heart SCORE) were collected. Retinal vascular network analysis was performed by means of Singapore “I” Vessel Assessment (SIVA) software. Principal component analysis was used to condense the information contained in the high number of variables provided and to identify independent retinal vascular patterns.ResultsOverall, 1069 photographs (1069 participants) were reviewed with SIVA software. The mean age was 80.0 ± 3.8 years. We extracted three vascular patterns summarizing 41.3% of the vascular information. The most clinically relevant pattern, Sparse vascular network, accounted for 17.4% of the total variance. It corresponded to a lower density in the vascular network and higher variability in vessel width. Diabetic participants with hypoglycemic treatment had a sparser vascular network pattern than subjects without such treatment (odds ratio, [OR], 1.68; 95% CI, 1.04–2.72; P = 0.04). Participants with no history of cardiovascular disease who had a sparser vascular network were associated with a higher Heart SCORE (OR, 1.76; 95% CI, 1.08–2.25; P = 0.02).ConclusionsThree vascular patterns were identified. The Sparse vascular network pattern was associated with having a higher risk profile for cardiovascular mortality risk at 10 years.

Background Contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) is frequent and associated with long-term renal impairment and mortality. Retinal vessel density (RVD) measured by OCT-Angiography could reflect the global cardiovascular burden of ACS patients and thus provide a fast and non-invasive assessment of the systemic microcirculation, that may be involved in CIN occurrence. Methods Between October 2016 and March 2017, 452 ACS patients were admitted in our coronary care unit. Retinal OCT-A was performed within two days after PCI. Patients were divided in two groups, according to Acute kidney injury (AKI) occurrence (KDIGO criteria, increase in creatinine > 26.5 μmol/L within 2 days or > 50% within 7 days after contrast injection). Results Of the 452 consecutive patients admitted for ACS during the inclusion period, 216 had a PCI and an analyzable OCT-A. Overall, AKI occurred in 21 (10%) patients. AKI was significantly associated with age (69 ± 14y vs. 62 ± 12y, P = 0.009), Mehran score (10.1 vs. 4.8, P Conclusion AKI after primary PCI for ACS was strongly and independently associated with low RVD evaluated with OCT-A. Moreover, this new retinal biomarker improved the predictive performance of Mehran and GRACE scores even after adjustment to NT-proBNP levels, suggesting that the microvascular systemic impairment is not currently taken into account neither by the classical risk score nor by the known clinical and biological factors associated to CIN onset.

International audience; Purpose: To estimate the prevalence of dry eye disease (DED) in the elderly and to describe systemic and ocular factors associated with DED in a population-based study, the Montrachet (Maculopathy Optic Nerve nuTRition neurovAsCular and HEarT diseases) study.Methods: Dry eye symptoms were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire. A self-reported history of dry eye symptoms and artificial tear use were also recorded. Every participant underwent an ophthalmic evaluation, which included the Schirmer test without anesthesia (Schirmer I), tear film breakup time (TFBUT) measurement, and fluorescein corneal staining evaluation.Results: A total of 1045 subjects were included in the study. The mean age was 82.2 +/- 3.8 years. The prevalence of DED according to symptoms, signs, or both was 34.4% [95% confidence interval ({CI)} 31.5-37.2], 34.5% [95% CI 31.6-37.3] and 13.0% [95% CI 10.9-15.0], respectively. Compared with men, women were more likely to self-report DED and artificial tear use, more often displayed an OSDI >22, and more often suffered from subjective and definite DED. In multivariate analysis, associated factors with definite DED were an educational level of short secondary school (to age 15 years), best-corrected visual acuity

Background Retinal microvascularisation abnormalities have been suggested to reflect severity of cardiovascular diseases. In patients with acute coronary syndrome (ACS), a low retinal vascular density, measured by OCT-angiography, has been strongly associated with cardiovascular risk scores and altered LVEF, beyond the classical risk factors. However, the vascular and hemodynamic determinants of RVD and their evolution after the acute event remain to be investigated. Methods Our study prospectively included patients admitted in a university hospital for an ACS, from May to October 2017. Retinal vascular density (RVD), intraocular pressure (IOP) and hemodynamic parameters including mean arterial pressure (MAP), and cardiac output from echocardiographic measurements were performed at the during hospitalization and three months later. Results Among the 25 patients included, 87% were men, with a mean age of 62 ± 11y, AHA score at 18.7 and the mean LVEF at 55(48–60)%. RVD was inversely correlated with AHA score (r = −0.335, P = 0.034). Between acute phase and 3 months follow-up, ocular parameters including RVD (19.7 ± 2.6 mm−1 vs. 19.3 ± 2.2 mm−1, P = 0.569), IOP (13.7 ± 2.7 mmHg vs. 14.3 ± 3,6 mmHg, P = 0.193), and cardiac parameters, cardiac output 2.43 ± 0.76 L/min/m2 vs. 2.55 ± 0.71 L/min/m2, and LVEF (55 ± 10% to 56 ± 7%, P = 0.129) remained stable. No significant association was found between RVD and Ocular Perfusion Pressure at the acute phase or at 3 months. Moreover, no correlation was found between RVD and cardiac output, neither at the acute phase nor 3 months later. Conclusion Our prospective study shows that in patients with ACS, retinal vascular density measured by OCT-A is independent from the hemodynamic status and from the left ventricular function. Moreover, no significant variation was observed between acute and three months later RVD values, strongly suggesting that this measurement mainly reflects a chronic alteration of the microvascular system.

Open access review article in open archive.; Background Retinal artery calibre correlates with the risk of cardiovascular events, and could serve as an inexpensive and reproducible biomarker for cardiovascular diseases. Recently, a non-invasive approach for retinal imaging with OCT angiography has been proposed to evaluate retinal blood vessel density. Methods The EYE-MI study prospectively included all consecutive patients admitted to our University Hospital for acute coronary syndrome (ACS) between October, 1st and December, 31st 2016. Patients with retinal diseases were excluded. Retinal OCT angiography was performed within 2 days after admission to assess inner retina vascular density (IRVD), based on blood flow. Results Of 212 patients admitted for ACS, 173 were included. Age was 62 ± 12 years and 79% were male. When compared with the higher tertiles of IVRD, patients with the lowest tertile were older, had more often hypertension, diabetes and previous renal failure. Strikingly, AHA and SCORE risks were higher. Moreover, patients in the lowest IRVD tertile had higher SYNTAX and GRACE scores, lower LVEF and a higher heart rate and systolic blood pressure, despite similar rates of beta-blockers and RAAS inhibitors. After multivariate analysis, only AHA risk score (OR (95% CI): 1.07 (1.04–1.10),) and LVEF (OR (95% CI): 0.95 (0.92–0.98)) were associated with the lowest retinal vascular density. The strong association between the AHA risk score and IRVD was confirmed by Pearson correlation coefficient (r = −0.48, P < 0.001) (Fig. 1). Conclusion In patients admitted for ACS, IRVD measured by OCT angiography was strongly associated with cardiovascular risk and with impaired LVEF. These preliminary results could help to target a specific population at high risk for cardiovascular events.