Search

Precision medicine is the future. In all fields of medicine, optimized therapy aims at identifying individuals at risks in order to prevent diseases, to identify specific molecular targets in a specific patient, at a specific time, to administer optimized treatment with less side effects. To achieve this ambitious aim, biomarkers, which should be specific and sensitive predictive indicators of diseases, or of response to treatment or of a state of evolution of the disease, must be identified. The eye offers an easy access organ to collect directly media or tissue, which can serve to identify such markers. This paper summarizes recent advances in the identification of ocular biomarkers of ocular diseases but also of brain diseases.La médecine de précision est la médecine du futur. Demain, on ne traitera plus un symptôme ou une maladie, on saura identifier les individus à risque de développer une maladie pour la prévenir, on traitera avec précision, une phase spécifique de la maladie chez un individu en particulier. Réaliser une thérapie optimisée, plus ciblée, associée à moins d’effets non spécifiques est notre objectif. Pour parvenir à cet objectif, des biomarqueurs doivent être définis et validés. L’œil est un organe isolé du reste de l’organisme par l’existence de barrières et par son privilège immunologique mais c’est aussi une fenêtre ouverte sur le cerveau. Les tissus et milieux oculaires sont une source insoupçonnée d’informations que les chercheurs commencent à découvrir. Cet article fait le point sur la médecine de précision en ophtalmologie.

The purpose of this paper is to describe and analyze the diagnosis and treatment of age-related macular degeneration (AMD) based on current guidelines.A study was conducted on a sample of French AMD patients covered by the RSI (public health insurance for self-employed workers), who received a first reimbursement in 2008 for treatments including verteporfin (Visudyne®), pegaptanib (Macugen®) and/or ranibizumab (Lucentis®). Data were collected retrospectively from the ophthalmologist by the medical adviser. Treatments were compared with the marketing authorisation for AMD drugs and therapeutic indications. Complementary examinations were also examined based on the recommendations of the Haute Autorité de Santé (HAS).184 patients were included in the sample. Lucentis® was used in 91.8% of cases. 62.0% of the patients treated with Lucentis® had subfoveal CNV. Visual acuity was good in 83.5% of cases. Fluorescein angiography (recommended by the HAS before treatment initiation) was performed in 87.5% of cases.The gap between guidelines and practice is illustrated by the case of Lucentis®, which is increasingly used for indications other than those reimbursed by health insurance. The findings indicate that the current price does not reflect sales volume estimates based on current guidelines, a problem that may be compounded by the recent extension of indications covered by health insurance.

Age-related macular degeneration (AMD) is the main cause of irreversible blindness in industrialized nations. Recent research has emphasized the importance of inflammatory processes in pathogenesis of this disease. Chemotactic cytokines also named chemokines are important mediators of inflammation and might have a role in development of this disease. They appear to be crucial in the subretinal microglia / macrophage accumulation observed in AMD and may participate in the development of retinal degeneration and in choroidal neovascularization. This paper reviews the possible implication of chemokines in the development of AMD.

International audience; Role of chemokines in the development of age-related macular degeneration. Age-related macular degeneration (AMD) is the main cause of irreversible blindness in industrialized nations. Recent research has emphasized the importance of inflam-matory processes in pathogenesis of this disease. Chemotactic cytokines also named chemokines are important mediators of inflammation and might have a role in development of this disease. They appear to be crucial in the subretinal microglia / macrophage accumulation observed in AMD and may participate in the development of retinal degeneration and in choroidal neovascularization. This paper reviews the possible implication of chemokines in the development of AMD.; La dégénérescence maculaire liéeà l'âge (DMLA) est la principale cause de cécité irréversible dans les pays industrialisés. Lesétudes récentes mettent en exergue l'importance des processus inflammatoires dans le développement de la maladie. Les cytokines chimiotactiques, dénommées chimiokines, qui apparaissent comme des médiateurs importants de l'inflammation, pourraient jouer un rôle dans le développement de la DMLA. Plus particulièrement, elles semblent indispensables dans le processus d'accumulation des microglies/macrophages dans l'espace sous-rétinien observé au cours de la DMLA. Elles pourraient par conséquent partici-per au développement de la dégénérescence rétinienne et de la néovascularisation choroïdienne. Dans cette revue, nous décrirons l'implication des chimiokines et de leurs récepteurs dans le développement de la DMLA.

The technique of intravitreous injections has been well documented for several years. Recently, a descriptive article on the intravitreous injections procedure was published in the Journal Français d'Ophtalmologie, and the AFSSAPS (French agency for drug safety) released recommendations concerning this matter on the occasion of commercial launch of pegaptanib. Since that time, the number of intravitreal injections has considerably increased, because anti-VEGF drugs had been made available to ophthalmologists, and several teams have performed a large number of procedures, allowing them to better comprehend intravitreous injections. The present paper describes our current practice of intravitreous injections. Several specialists have exchanged their experiences and issued a common synthesis. Detailed modifications of the initial recommendations have been suggested, with such basic changes such as abandoning preoperative pupil dilatation and easing postsurgical monitoring. Follow-up examinations should be adapted to each patient rather than being systematic. The suggested modifications do not change the procedure of intravitreous injections substantially, but they simplify many steps and detail the various procedures when consensus is lacking.

Ocular neovascularizations are responsible for irreversible loss of vision in various diseases, including age-related macular degeneration. Treatments have changed greatly, and photodynamic therapy with verteporfin has come into common use. However, the visual prognosis remains poor. The recent approval of new antiangiogenic molecules such as ranibizumab and pegaptanib should allow for new therapeutical possibilities. The unapproved ophthalmological use of bevacizumab requires further studies. This paper updates what is known about old and new neovascularization treatments: their mechanism of action, their efficacy, and their toxicity. It reviews the principal clinical studies, and concludes with the recognized recommendations. For the first time, ophthalmologists can hope not only to stabilize loss of vision, but also to improve visual acuity. Complementary treatments can now be tested in associations, concomitantly or not, with the hope of improving visual results.

Transpupillary thermotherapy (TTT) has been proposed over the last a few years for the treatment of subfoveal occult choroidal neovessels resulting from age-related degeneration (AMD) when they are symptomatic and associated with exudation. Several pilot studies have shown how this technique can decrease or slow down the progression of exudation related to choroidal neovessels. Based on these pilot studies, a randomized study (TTT4CNV) is in progress to evaluate the efficacy of TTT. While the inclusion of the patients in this study has come to an end, the therapeutic context of AMD has recently been changed with a permit to market Visudyn for photodynamic therapy (PDT) for some types of subfoveal occult choroidal neovessels. Moreover, the clinical studies in progress on photodynamic therapy and antiangiogenic drugs now make it possible to consider combined treatments possibly including TTT. This paper aims to provide a report on the current place and potential of TTT within the therapeutics available or soon available for subfoveal occult choroidal neovessels of AMD.