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Purpose To evaluate the time required to complete a cataract training program for first-year ophthalmology residents using the EyeSi simulator. In addition, evaluate whether the simulator improves virtual performance of cataract surgery during the program. Methods We prospectively included first-year ophthalmology residents who had no experience of cataract surgery. The EyeSi simulator was used, and residents were able to follow the cataract training program, including course A (the easiest) through to course D (the hardest). In course B and above, a “cataract challenge” is proposed to the trainee every hour of simulation. Results A total of 24 participants were included in the study. During the study period, the mean (SD) total time spent on the surgical simulator was 815.6 (174.7) minutes. All the participants completed courses A and B within a mean (SD) of 366.7 (108.0) minutes. A total of 22 residents (91.7%) residents completed course C, and 5 (20.8%) course D. The mean (SD) best score on cataract challenge was 445.6/500 (40.2; range: 330–493) and was obtained in a mean (SD) 7.6 (2.6) attempts. All the residents obtained a score ≥ 60%. The best score in cataract challenge was not correlated to the time spent to achieve courses A and B (r = -0.37, p = 0.0726). Conclusions The time required to complete a basic cataract training program is possible during the first-year residency. The scores obtained in the cataract challenge also increased during the training program and should lead to better surgery skills in these young ophthalmologists.

To evaluate choriocapillaris alterations following proton beam therapy irradiation using swept-source optical coherence tomography-angiography, and to assess their correlation with the grade of radiation retinopathy (RR).Eyes with uveal melanoma evaluated before and after irradiation with proton beam therapy were included, as well as the healthy fellow eye. The gradation of RR was based on a previously published classification. Choriocapillaris flow voids area was analyzed using Phansalkar thresholding. Retinal vascularization was described by foveal avascular zone (FAZ) perimeter, FAZ area, FAZ circularity index, and percentage of nonperfusion area (PAN) in the superficial capillary plexus (SCP) or deep capillary plexus.A total of 157 eyes of 83 patients were analyzed. Overall, there was a significant difference between the control group, the uveal melanoma before proton beam therapy group, and the grades of RR in the uveal melanoma after proton beam therapy group for FAZ perimeter ( P0.001), FAZ area ( P0.001), FAZ-circularity index ( P0.001), PAN-SCP ( P0.001), PAN-deep capillary plexus ( P0.001), and choriocapillaris flow voids area ( P0.001). Moreover, choriocapillaris flow voids area was significantly increased in the early stages of RR ( P = 0.003) and was further significantly correlated with FAZ perimeter ( P0.001), FAZ area ( P0.001), FAZ-circularity index ( P = 0.010), PAN-SCP ( P0.001), and PAN-deep capillary plexus ( P0.001).Quantitative optical coherence tomography-angiography alterations in the choriocapillaris microvascularization are an early biomarker of RR and are correlated to the severity of the disease.

To report a cohort of patients diagnosed with retinal metastases (RM), and to integrate these new cases in a systematic review of the literature, analyzing the clinical features and prognosis factors of patients with RM.We conducted a retrospective multicenter study including patients with RM. We also performed a full literature review of all published cases with a diagnosis of RM.A total of six new cases were described on multimodal imaging. By combining the data from the literature and from our patients, we report the characteristics of a total of 69 patients. The most frequent primary tumor sites were cutaneous melanoma (36%), lung (23%), gastrointestinal tract (17%), and breast (12%). Multimodal imaging highlighted specific characteristics of RM. Fluorescein and indocyanine green angiography revealed early hypofluorescence followed by progressive filling of intrinsic dilated vessels. Optical coherence tomography demonstrated a hyperreflective intraretinal mass in all cases with or without subretinal fluid, hyperreflective intraretinal dots, or intraretinal fluid. Ultrasonography revealed a medium-high reflective dome-shaped tumor. Fifty-nine percent of the patients died during the follow-up with a mean survival time of 8.8 ± 8.7 months.We described here the clinical spectrum of RM and highlighted specific features of the disease.

Purpose To evaluate early predictive factors of visual loss in patients treated with anti–vascular endothelial growth factor (VEGF) injections under an as-needed regimen for neovascular age-related macular degeneration (AMD). Design Post hoc analysis from the randomized controlled trial Groupe d’Evaluation Francais Avastin versus Lucentis (GEFAL). Participants A total of 393 patients with neovascular AMD. Methods The present analysis is based on 1-year data from patients included in the study. Patients were separately categorized according to the best-corrected visual acuity (BCVA) change at 3 months and 1 year into 3 trajectories: (1) patients with no vision loss ≥5 letters at 3 months and 1 year (absence of loss ≥5 letters); (2) patients with no vision loss ≥5 letters at 3 months but loss ≥5 letters at 1 year (secondary loss ≥5 letters); and (3) patients with vision loss ≥5 letters at 3 months and 1 year (initial loss ≥5 letters). Main Outcome Measures The following factors were evaluated at baseline and 3 months: age, sex, BCVA, presence of fluid, central macular thickness, angiographic choroidal neovascularization (CNV) subtype, CNV area measured in disc area on fluorescein angiography, and number of intravitreal injections. Results An absence of loss ≥5 letters was found in 225 patients (57.3%), a secondary loss ≥5 letters after 3 months was found in 109 patients (27.7%), and an initial loss ≥5 letters was found in 59 patients (15%). Baseline characteristics were comparable among the 3 groups except for the total CNV area, which was larger in the initial and secondary loss groups (P = 0.0412). At 3 months, a significant association was found between presence of subretinal fluid (SRF) (P = 0.0318) and vision loss ≥5 letters, and an even stronger significant association between the presence of intraretinal fluid (IRF) (P = 0.0066) and vision loss ≥5 letters. Conclusions In the present study, we found that a large CNV area at baseline was significantly associated with initial or secondary loss of visual acuity ≥5 letters despite anti-VEGF injection. The presence of fluid, both SRF and IRF, at 3 months was found in patients with poorer trajectories.

The aim of this study is to assess if the decision to retreat could be determined by anatomical criteria (mostly driven by optical coherence tomography (OCT)-guided strategy) rather than the gold standard (visual acuity (VA) and OCT) in patients with neovascular age-related macular degeneration (nAMD). A cross-sectional study of 142 eyes already treated for nAMD from September 2021 to December 2021 was performed. At inclusion, a first therapeutic decision was made based on the analysis of the OCT. This decision was then maintained or modified after being made aware of the patient’s VA. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. The OCT-guided strategy matched the gold standard for treatment decisions in 131 of the 142 eyes included (92.3%). The sensitivity and specificity of the OCT-guided strategy for the retreatment decision were 94.0% and 89.8%, respectively. PPV and NPV were 92.9% and 91.4%, respectively. Considering the treatment regimen, eyes followed under the Pro ReNata regimen showed better sensitivity (100%) and specificity (93.3%) than eyes followed under the treat and extend regimen (93.5% and 88.6%, respectively). Based on the findings of this study, the follow-up for selected patients with nAMD under anti-VEGF treatment could be monitored without regular VA testing with acceptable performance.

OBJECTIVE: To evaluate the effect of initial treatment regimen individualization, (Pro Re nata (PRN) or Treat-and-Extend (TAE)), according to macular neovascularization (MNV) subtype, on the functional and anatomical response in neovascular age-related macular degeneration (nAMD). The secondary objective is to compare the treatment burden between each MNV subtypes. METHODS: Consecutive treatment-naïve nAMD patients were retrospectively included. MNV subtype was graded by 2 independent blinded investigators on multimodal imaging. Functional and anatomical outcomes were analysed according to treatment regimen and MNV subtypes. RESULTS: A total of 281 eyes from 243 patients were included in the study. According to the treatment regimen, there was no significant difference in best-corrected visual acuity gain within the 2 first year of treatment for type 1 (p=0.106) and type 3 MNV (p=0.704). Conversely, there was a significant difference in favour of TAE regimen for type 2 (p=0.017) and type 4 MNV (p=0.047). Type 1 MNV had a higher proportion of visits with subretinal fluid (p=0.0007), but not with intraretinal fluid (p=0.22). The mean interval between the last 2 injections was significantly shorter for type 1 MNV (p=0.0045). CONCLUSION: The individualization of the initial treatment protocol according to MNV subtype can improve the functional outcome and may decrease the treatment burden.

The last decade has witnessed important advances in retinal drug discovery, administered intravitreally, allowing high intraocular concentration and low systemic passage. However, local and systemic adverse events have been described and should be discussed before proposing treatment. In diabetes mellitus specifically, the choice of molecule and treatment regimen should limit the therapeutic burden, avoiding the need for frequent ophthalmological appointments, in patients receiving multi-disciplinary care.We aim to review and discuss the risk/benefit ratio of the main intravitreal therapies currently proposed for diabetic macular edema (DME), and how these treatments could be tailored to each individual patient.Anti-VEGF injections and steroid implants are currently the two therapeutic options proposed in cases of DME. New molecules in these two classes have recently been approved and are currently being studied under phase IV observations to establish their efficacy and tolerance. The preferred therapeutic option is determined based on the ocular condition and the patient profile. As new treatments are developed, new adverse events will also enter into consideration, and retinal physicians must therefore be able to call on a range of therapeutic options and question the risk/benefit ratio of each of them before proposing a treatment.

The aim of this study was to compare primary versus secondary forms of multiple evanescent white dot syndrome (MEWDS) at T0 (baseline) and T1 (1-4 months after the onset of symptoms).A total of 101 eyes in 100 patients were included in a multicentric retrospective study.Secondary MEWDS was defined as MEWDS associated with underlying chorioretinal inflammatory pathologies, mainly multifocal choroiditis and punctuate inner choroidopathy. Patients with secondary MEWDS were older (P = 0.011). The proportion of women (P = 0.8), spherical equivalent (P = 0.3), and best-corrected visual acuity at T0 (P = 0.2) were not significantly different between the two groups. The area of MEWDS lesions on late-phase indocyanine green angiography was significantly smaller in secondary MEWDS (P = 0.001) and less symmetrical with respect to both horizontal (P = 0.003) and vertical (P = 0.004) axis. At T0, neither the clinical (P = 0.5) nor the multimodal imaging (P = 0.2) inflammation scores were significantly different between the groups. At T1, the multimodal imaging inflammation score was higher in secondary MEWDS (P = 0.021).In secondary MEWDS, outer retinal lesions are less extensive and located close to preexisting chorioretinal lesions. Mild signs of intraocular inflammation on multimodal imaging are more frequent in secondary MEWDS during recovery. These findings suggest that chorioretinal inflammation may trigger secondary MEWDS.

To describe endogenous endophthalmitis in the setting of COVID-19 pneumonia.Patients recovering from COVID-19 pneumonia who presented to our department with any or all of the following complaints: pain, watering, redness, and decreased vision were identified. All relevant data were collected for analysis.Three patients with endogenous endophthalmitis were identified. All patients had been treated for COVID-19 pneumonia and therefore had received remdesivir and systemic steroids; 2 of the 3 patients received tocilizumab. All patients received vitreous biopsy, vitrectomy, and intraocular antibiotic injection. Patient 1 demonstrated Klebsiella pneumoniae in blood culture, K. pneumoniae and Escherichia coli in urine culture, and K. pneumoniae in vitreous fluid, whereas Patients 2 and 3 demonstrated Stenotrophomonas maltophilia and methicillin-resistant Staphylococcus aureus in the blood and nasopharyngeal culture, respectively. Correspondingly, the same organism was cultured from vitreous in Patients 2 and 3. The visual acuity at the last follow-up in Patients 1 to 3 was 20/100, 20/80, and 20/40, respectively. The probable source of infection was identified in each as renal calculi, dental caries, and the pharynx, respectively. Real-time polymerase chain reaction demonstrated the presence of Severe Acute Respiratory Syndrome Coronavirus 2 in the vitreous fluid of Patient 1.We report good outcomes of early intervention for endogenous endophthalmitis in the setting of COVID-19 infection. We also document the presence of SARS-CoV-2 in vitreous.

International audience; Background: The aim of this study was to describe the value of the Odysight (R) application in addition to a classical follow-up regimen in the detection of exudative recurrences in patients with macular edema. Methods: We conducted an observational, multicenter, retrospective study. The Odysight (R) application includes a visual acuity (VA) test that can lead to alerts in case of a drop of >5 VA letters on two successive tests. The efficacy of the alerts in detecting exudative recurrence was studied. Results: A total of 149 eyes of 123 patients were included. The sensitivity of alerts for the detection of recurrence was 30.8% (95% CI [17.6; 44.0]) and its specificity was 83.7% (95% CI [73.2; 94.3]). A better baseline VA was found to be significantly associated with a better retention of the application (OR = 0.05, 95% CI [0.002; 0.62]; p = 0.045). Of the 12/39 alerts that detected a recurrence, eight (20.5% of all alerts) resulted in the scheduling or advancement of an intravitreal injection. Conclusions: In the present study, the sensitivity and positive predictive value of the Odysight (R) application seems low but its use in addition to the usual follow-up of the patient can detect, in certain cases, an early recurrence and thus allow an anticipated readjustment of the treatment.

To report the clinical findings, therapy and outcomes of pauci-symptomaticRetrospective, observational study that looks at 11 patients who demonstratedA total of 11 eyes of 11 patients were included in the analysis and were followed for at least 12 months. All patients responded completely to local and systemic voriconazole therapy. The source of infection was noted to be air-conditioning vents. Eyes with manual small incision cataract surgery (11/17) had a higher propensity for infection.Pauci-symptomatic aspergillosis infection has been reported here following cataract surgery.

To evaluate mean change in best-corrected visual acuity (BCVA) at 52 weeks in patients with inflammatory choroidal neovascularization (CNV) treated with aflibercept.We conducted a prospective non-comparative open-label trial. Following one mandatory intravitreal injection of aflibercept, patients were treated under a pro re nata (PRN) dosing regimen with monthly visits.A total of 19 patients were included, but one presented exclusion criteria; 16 patients were followed for the whole 52-week study, and data for the primary endpoint analysis were available for 14. At baseline, mean BCVA and mean central retinal thickness (CRT) were 64.53 (±19.64) letters and 351.79 (±97.77) μm, respectively. At 52 weeks, the mean change in BCVA was +9.50 (±12.90) letters [95%CI = +2.05-+16.95]. One patient had lost more than 15-letters at 24 weeks, and another one at 52 weeks. CRT change was -62.77 (±100.73) μm at 24 weeks and -66.53 (±97.47) μm at 52 weeks. There was a mean number of 3.56 (±3.29) intravitreal injections at 52 weeks (min = 1; max = 12). No serious ocular adverse events related to the treatment were reported.Our study shows that aflibercept is clinically effective, both anatomically and functionally in the treatment of inflammatory CNV. Following the first injection, the PRN strategy appears sufficient for treating most choroidal neovessels.

AimTo assess the relevance of therapeutic drug monitoring (TDM) of adalimumab (ADA) treatment for the control of intraocular inflammation and treatment adjustment in chronic non-infectious uveitis (CNIU).MethodsRetrospective study of CNIU patients treated with ADA and for whom at least one dosage of serum ADA level and an antibodies against ADA (AAA) serology were performed, between June 2003 and July 2019.ResultsA total of 44 ADA-treated patients benefited from a TDM. A total of 48/79 (61%) TDM were performed in responders, 11/79 (14%) in primary non-responders, and 20/79 (25%) in secondary non-responders. Responders had significantly higher ADA levels than non-responders (p=0.0004). AAA were detectable in six patients, they were primary non-responders (n=2), secondary non-responders (n=3) or responders (n=1). In the five non-responders and immunised patients, ADA was switched (to golimumab or methotrexate). Among non-responders, TDM led to an increased frequency of injections 12/31 (38%), increased dose 1/31 (3%) and switch of treatment 10/31 (32%) (one missing data). No modification of biotherapy was performed 7/31 (22%) and only local or oral corticotherapy was adjusted. In 24/31 cases of therapeutic adjustment in non-responders, an improvement was observed in 87% of cases. Among responders for whom the ADA level was above the efficacy threshold, the frequency of injections was decreased for 15/31 (48.4%) cases and no relapse was observed in 12/15 (80%) cases.ConclusionTDM of ADA treatment proved relevant to provide CNIU patients with a personalised and optimised treatment course (in terms of frequency and type of drug).

Purpose Numerous small hyperreflective dots (HRDs) can be seen within the hyporeflective layer between the ellipsoid zone (EZ) and the interdigitation zone (IZ) on C‐scan spectral‐domain optical coherence tomography (SD‐OCT) with a yet unknown variation under light conditions. The aim of this study was to explore light‐induced SD‐OCT changes in these HRDs. Methods The study subjects were randomly assigned to two groups: Group 1 experienced a dark adaptation protocol followed by intense retinal photobleaching, while Group 2, serving as the control group, was exposed to constant ambient light without any variation. The number of HRDs was automatically counted. Results Twenty healthy volunteers were prospectively included. The number of HRDs differed significantly over time (p = 0.0013). They decreased in Group 1 after dark adaptation and retinal photobleaching before returning to baseline levels 30 min later; conversely, they remained relatively constant in Group 2 throughout the study (p

To determine the effect of commonly used intravitreal agents on immediate and long-term IOP elevations and their association, if any, with glaucoma. Literature searches in PubMed and the Cochrane databased in January 2020 yielded 407 individual articles. Of these, 87 were selected for review based on our inclusion criteria. Based on the evidence provided, 20 were assigned level I, 27 level II, and 22 level III. Eight articles were rejected because of poor quality, insufficient clarity, or irrelevance based on standardized protocols set out by the American Academy of Ophthalmology. The studies that reported on short-term IOP elevation (i.e., between 0 and 60 min) showed that an immediate increase in IOP is seen in all patients who receive anti-VEGF agents or triamcinolone acetonide when measured between 0 and 30 min of intravitreal injection and that the IOP elevation decreases over time. The data on long-term IOP elevation were mixed; Pretreatment with glaucoma medications, anterior chamber tap, vitreous reflux, longer intervals between injections, and longer axial lengths were associated with lower IOP elevations after injection of anti-VEGF agents, while the position of the implant vis-à-vis, the anterior chamber was important for steroid therapy. Data were mixed on the relationship between IOP increase and the type of intravitreal injection, number of intravitreal injections, preexisting glaucoma, and globe decompression before injection. There were no data on the onset or progression of glaucoma in the studies reviewed in this assessment. However, some studies demonstrated RNFL thinning in patients receiving chronic anti-VEGF therapy. Most, if not all, intravitreal agents cause ocular hypertension, both in the short term and long term. The functional consequences of these observations are not very clear.

(1) Background: to investigate the correlation between structural (retinal ganglion cells and retinal nerve fibers) and functional alterations analyzed point-by-point in the central 10 degrees of the visual field of patients with advanced glaucoma using Humphrey 10-2 visual field tests. (2) Methods: Single-center prospective cohort study carried on from October 2018 to February 2019 at the Croix-Rousse hospital, Lyon, France. The primary outcome measure was the point-by-point correlation between retinal sensitivity (Humphrey 10-2) and retinal ganglion cell complex (GCC) thickness. (3) Results: 29 eyes of 27 patients were examined. Of these, 15 eyes had a mean deviation (MD) less than −20 dB. There were statistically significant linear relationships between GCC thickness and 10-2 visual field sensitivity for several points in the lower part of the visual field, with lower retinal sensitivity being associated with thicker GCC layers. There were no strong linear relationships or statistically significant correlations in the other regions of the visual field. For the patients with MD < −20 dB, there were statistically significant linear relationships between GCC thickness and 10-2 visual field sensitivity for several points in the superior nasal region. Retinal sensitivity was not correlated with retinal nerve fibre layer thickness. (4) Conclusions: In this study of patients with advanced glaucoma, GCC thickness was linearly associated with 10-2 visual field sensitivity in certain regions, negatively for patients with less-severe glaucoma. The initial thickening raises questions about the apoptosis mechanism, while the thinning observed in the most severe cases is consistent with the ganglion cell death identified on visual field tests.

To describe the effectiveness of the XENWe report the case of a 54-year-old man with a history of uveitic glaucoma on his left eye due to Fuchs heterochromic iridocyclitis and neovascular glaucoma after a central retinal vein occlusion. Pre-operative intraocular pressure was 30 mmHg despite a QD (once-daily) dosed bimatoprost 0.3 mg and timolol 5 mg topical medication. At week 1, the eye exam showed an intraocular pressure of 6 mmHg with a well-formed bleb, a very mild hyphema and a localized choroidal detachment. At month 1, intraocular pressure was 14 mmHg with a formed bleb. Both hyphema and choroidal detachments had resolved. After a year, intraocular pressure was 16 mmHg without any medication and the bleb was still well-formed.The XEN

The aim of this review is to identify the common characteristics and prognoses of different subtypes of neovascular age-related macular degeneration (nAMD). We also propose recommendations on how to tailor treatments to the subtype of neovessels to optimise patient outcomes. The authors, selected members of the Vision Academy, met to discuss treatment outcomes in nAMD according to macular neovascularisation (MNV) subtypes, using evidence from a literature search conducted on the PubMed database (cut-off date: March 2019). This review article summarises the recommendations of the Vision Academy on how the characterisation of MNV subtypes can optimise treatment outcomes in nAMD. The identification of MNV subtypes has been facilitated by the advent of multimodal imaging. Findings from fluorescein angiography, indocyanine green angiography and spectral-domain optical coherence tomography collectively help refine and standardise the determination of the MNV subtype. To date, three subtypes have been described in the literature and have specific characteristics, as identified by imaging. Type 1 MNV is associated with better long-term outcomes but usually requires more intense anti-vascular endothelial growth factor dosing. Type 2 MNV typically responds quickly to treatment but is more prone to the development of fibrotic scars, which may be associated with poorer outcomes. Type 3 MNV tends to be highly sensitive to anti-vascular endothelial growth factor treatment but may be associated with a higher incidence of outer retinal atrophy, compared with other subtypes. Accurately assessing the MNV subtype provides information on prognosis and helps to optimise the management of patients with nAMD.摘要: 本综述的目的是确定新生血管性年龄相关性黄斑变性 (nAMD) 不同亚型的特征和预后.并建议如何根据新生血管的亚型调整治疗方案, 以优化患者的预后.作者为视觉学会的选定成员, 根据黄斑区新生血管 (MNV) 的不同亚型, 利用PubMed数据库中检索的文献 (截止日期: 2019年3月),讨论了nAMD的治疗效果.这篇综述文章总结了视觉学会关于不同MNV亚型如何优化nAMD治疗结果的建议.多模式成像促进了MNV亚型的识别.荧光素血管造影术、吲哚菁绿血管造影术和谱域光学相干断层扫描的结果共同完善并标准化了MNV亚型的确定.迄今为止,文献中已经描述了三种亚型,并通过成像确定了它们的具体特征.1型MNV具有更好的长期预后,但通常需要更高剂量的抗血管内皮生长因子.2型MNV通常对治疗反应迅速,但更容易形成纤维化瘢痕,这可能与较差的预后相关.3型MNV往往对抗血管内皮生长因子治疗高度敏感,但与其他亚型相比,可能与更高的视网膜外萎缩发生率相关.准确评估MNV的亚型可提供预后的信息,并有助于优化nAMD患者的管理.

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