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Introduction Information about real-world ranibizumab use is needed to optimize treatment of macular edema secondary to retinal vein occlusion (RVO). The BOREAL-RVO study assessed treatment use, effectiveness and safety of 24-month treatment with ranibizumab 0.5 mg in patients with visual impairment due to macular edema secondary to RVO in a real-world setting. Methods This was a multicenter, post-authorization, observational study in France, including patients starting ranibizumab for RVO. Primary endpoint was mean change from baseline in best-corrected visual acuity (BCVA) at Month 6. Secondary endpoints were mean changes from baseline in BCVA at Month 24 and central retinal thickness (CRT) at Months 6 and 24, and treatment use in real-world setting. Results 226 branch RVO (BRVO) and 196 central RVO (CRVO) patients were enrolled; 71.7% and 70.9% completed the 24-month follow-up, respectively. In BRVO, mean (SD) baseline BCVA was 55.2 (18.7) letters, with gains of 14.3 (13.7), 14.1 (16.5), 13.0 (17.5) and 11.4 (20.1) letters at Months 3, 6, 12 and 24. In CRVO, mean (SD) baseline BCVA was 40.4 (25.6) letters, with gains of 16.0 (21.2), 9.5 (25.4), 9.2 (27.7) and 8.3 (23.8) letters at Months 3, 6, 12 and 24. At Month 24, 52% of BRVO and 41% of CRVO patients had gains of 15 or more letters. In BRVO, mean (SD) CRT values at baseline and Months 3, 6, 12 and 24 were 550 (175), 315 (104), 343 (122), 335 (137) and 340 (105) μm. In CRVO, mean (SD) CRT values at baseline and Months 3, 6, 12 and 24 were 643 (217), 327 (152), 400 (203), 379 (175) and 348 (161) μm. On average, BRVO patients had 3.8 injections for 6.9 visits by Month 6, and 7.2 injections for 19.7 visits by Month 24. CRVO patients had 2.7 injections for 4.2 visits by Month 6, and 7.1 injections for 21.1 visits by Month 24. Factors predictive of better BCVA gain at Month 6 were age under 60 at baseline, lower baseline BCVA and BCVA gain at Month 3. There were no new safety findings. Conclusion Major improvements in BCVA and CRT were observed at Month 3 after the induction phase, and then was sustained up to Month 24, with a slight decrease, probably due to under-treatment. This study demonstrated ranibizumab to be a safe and effective treatment for BRVO and CRVO in the real-world setting, although more regular or pro-active treatment could further improve outcomes.

Purpose: The lens-iris diaphragm retropulsion syndrome (LIDRS) corresponds to a brutal deepening of the anterior chamber during phacoemulsification. LIDRS is painful for the patient and sometimes causes intraoperative complications. This study was designed to assess the preoperative risk factors of LIDRS. Setting: Monocentric study in the university department of ophthalmology, Intercommunal Hospital Center, Creteil, France. Design: Prospective open-label observational study. Methods: Preoperative parameters of consecutive patients who underwent cataract surgery were recorded. LIDRS occurrence was evaluated during surgery and classified into 3 stages. Except for the first patient, a simple and rapid maneuver to separate the iris from the capsule (capsular touch) was performed in all patients with LIDRS. Results: LIDRS occurred in 101 out of 205 included eyes: mild in 73.2% (74/101) , marked in 16.8% (17/101) and severe in 9.9% (10/101). LIDRS eyes had a longer axial length (pConclusions: Myopia and prior vitrectomy were the main risk factors of LIDRS. The capsular touch allowed to resolve LIDRS in almost all eyes. Analysis of preoperative factors can help the surgeon to identify patients at risk and to prevent patient pain and intraoperative complications associated with LIDRS.

Upon completion of this activity, participants will be able to: In support of improving patient care, this activity has been planned and implemented by Medscape, LLC and Springer Nature. Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 1.0 Release date: Expiration date: 19 April 2020 Post-test link: https://medscape.org/eye/posttest924758 Sobha Sivaprasad, MD, has disclosed the following relevant financial relationships: Served as an advisor or consultant for: Allergan, Inc.; Bayer AG; Boehringer Ingelheim Pharmaceuticals, Inc.; Heidelberg Pharma GmbH; Optos; Roche. Served as a speaker or a member of a speakers bureau for: Allergan, Inc.; Bayer AG; Novartis Pharmaceuticals Corporation; Optos. Received grants for clinical research from: Allergan, Inc.; Bayer AG; Boehringer Ingelheim Pharmaceuticals, Inc.; Novartis Pharmaceuticals Corporation; Optos. EOZ, MD, has disclosed no relevant financial relationships. BP, MD, has disclosed no relevant financial relationships. SO, MD, has disclosed no relevant financial relationships. SB, MD, has disclosed the following relevant financial relationships: served as a speaker or a member of a speakers bureau for: Allergan, Inc.; Bayer AG; Novartis Pharmaceuticals Corporation. RAA, MD, MPH, has disclosed no relevant financial relationships. FK, MD, has disclosed no relevant financial relationships. GG, MD, has disclosed no relevant financial relationships. AS, MD, has disclosed no relevant financial relationships. NA, MD, has disclosed no relevant financial relationships. Laurie Barclay, MD, Freelance writer and reviewer, Medscape, LLC, and has disclosed no relevant financial relationships. To evaluate the efficacy and safety of pars plana vitrectomy for symptomatic floaters. Forty-eight vitreoretinal surgeons from 16 countries provided information on 581 eyes who underwent vitrectomy for floaters in this retrospective survey study conducted by European VitreoRetinal Society. Percentage symptomatic improvement, incidence of retinal tears/detachment and post-vitrectomy cataract surgery, and the factors associated with satisfaction and complications were investigated. Ninety-two percent were satisfied with the results, with 86.3% reporting complete resolution of daily-life symptoms. Overall satisfaction was lower in patients with smaller vitreous opacities at presentation (OR:0.4). Iatrogenic retinal breaks occurred in 29 eyes (5%). Core vitrectomy and cut rates of 1500–4000 or >4000 cuts/min were associated with lower risk of retinal breaks than complete vitrectomy (OR:0.05) and cut rates 1500 cuts/min are favoured. Proper patient selection and informed consent are the most important aspects of surgery.

Purpose: To assess the efficacy, safety, and follow-up of 36-month treatment with ranibizumab in patients with diabetic macular edema (DME) in real-life setting. Methods: This is a prospective phase 4 observational study. Between December 2013 and April 2015, 84 ophthalmologists enrolled a total of 290 adult patients initiating ranibizumab for visual impairment due to DME and treated them according to their routine practice. The primary outcome (mean change in best-corrected visual acuity [BCVA] after 12 months) was previously reported. Here, we present outcomes after 36 months of follow-up for BCVA and change in central subfield thickness (CSFT) and report how participating ophthalmologists treated DME over a 3-year period (number of visits and injections and evolution of treatment strategy). Results: Of the 290 patients enrolled, 187 (64.5%) completed the 36 months of the study (entire cohort). In the entire cohort, 97 patients were treated exclusively with ranibizumab throughout the study, and 90 patients switched to other intravitreal treatments. Mean BCVA was 64.2 (20.1) letters, representing a gain of +4.1 (19.9) letters from baseline to month 36 (M36). CSFT improved over the study, and by M36 had decreased by 127 (138) µm compared to baseline. Over the 36 months of follow-up, patients in the entire cohort paid their ophthalmologists a mean of 30.9 (12.2) visits and had a mean of 7.6 (5.2) any injections. Results for quality of life questionnaires NEI-VFQ25 and HUI-3 remained stable throughout the study. Multivariate analysis on the 145 patients with evaluable BCVA data at M36 found that male gender and milder baseline DME characteristics (BCVA ≥59 and CSFT

PURPOSE To study correlations in patients with retinal vein occlusion between the automatically quantified macular vascular densities in the superficial and deep capillary plexus (DCP) obtained using optical coherence tomography angiography (OCTA) and the data from conventional examination, particularly visual acuity and peripheral retinal nonperfusion assessed using fluorescein angiography (FA). METHODS Retrospective, observational study of patients with retinal vein occlusion who underwent a comprehensive ophthalmic examination including FA and OCTA using the AngioVue OCTA system version 2015.100.0.35 (OptovueRTVue XR 100; AVANTI, Inc, Fremont, CA). Vascular densities in the superficial capillary plexus and DCP, as well as the area of the foveal avascular zone, were measured using the AngioAnalytics software. RESULTS Our study of 65 eyes of 61 patients (33 men, mean age: 67 years) showed a significant correlation between peripheral nonperfusion on FA and (1) automatically quantified global vascular density in both plexus (P = 0.021 for the DCP) and (2) foveal avascular zone area (P = 0.037). We also found significant correlations between capillary dropouts in both plexus and peripheral nonperfusion (P < 0.001 for both) and between visual acuity and vascular densities (P = 0.002 for the global density in the DCP). Global density less than 46% in the DCP was associated to the presence of peripheral nonperfusion area on FA (P = 0.003) and to enlargement of the superficial foveal avascular zone (P = 0.002). CONCLUSION Our study demonstrated a significant correlation between automatically quantified macular vascular density on OCTA and peripheral nonperfusion on FA; OCTA could help identify high-risk retinal vein occlusion patients who may benefit from further evaluation using FA.

Optical coherence tomography angiography is a noninvasive examination, which allowed automated measurements of vascular density at the level of the superficial and deep capillary plexus. Correlations were found in patients with retinal vein occlusion between the automatically quantified macular vascular densities obtained using optical coherence tomography angiography and the data obtained from conventional examination, particularly visual acuity and peripheral retinal nonperfusion assessed using fluorescein angiography., Purpose: To study correlations in patients with retinal vein occlusion between the automatically quantified macular vascular densities in the superficial and deep capillary plexus (DCP) obtained using optical coherence tomography angiography (OCTA) and the data from conventional examination, particularly visual acuity and peripheral retinal nonperfusion assessed using fluorescein angiography (FA). Methods: Retrospective, observational study of patients with retinal vein occlusion who underwent a comprehensive ophthalmic examination including FA and OCTA using the AngioVue OCTA system version 2015.100.0.35 (OptovueRTVue XR 100; AVANTI, Inc, Fremont, CA). Vascular densities in the superficial capillary plexus and DCP, as well as the area of the foveal avascular zone, were measured using the AngioAnalytics software. Results: Our study of 65 eyes of 61 patients (33 men, mean age: 67 years) showed a significant correlation between peripheral nonperfusion on FA and (1) automatically quantified global vascular density in both plexus (P = 0.021 for the DCP) and (2) foveal avascular zone area (P = 0.037). We also found significant correlations between capillary dropouts in both plexus and peripheral nonperfusion (P < 0.001 for both) and between visual acuity and vascular densities (P = 0.002 for the global density in the DCP). Global density less than 46% in the DCP was associated to the presence of peripheral nonperfusion area on FA (P = 0.003) and to enlargement of the superficial foveal avascular zone (P = 0.002). Conclusion: Our study demonstrated a significant correlation between automatically quantified macular vascular density on OCTA and peripheral nonperfusion on FA; OCTA could help identify high-risk retinal vein occlusion patients who may benefit from further evaluation using FA.

Purpose: To study the association between the assessment of central macular vascular layers by optical coherence tomography angiography (OCT-A) and peripheral nonperfusion evaluated by fluorescein angiography (FA) in patients with retinal venous occlusion (RVO). Methods: Retrospective review of RVO patients without macular edema. Patients underwent a comprehensive ophthalmic examination including FA, spectral-domain OCT, and OCT-A. Significant ischemia was defined as nonperfusion areas superior or equal to the equivalent of one retinal quadrant on FA. Vascular density (VD) and foveal avascular zone were measured using AngioAnalytics software. Fractal dimension (FD) and lacunarity (LAC) were computed using an algorithm designed by MATLAB (MathWorks, Natick, MA). These variables were used to build a model that translates their association with OCT-A parameters. Results: There were 48 eyes (48 patients) of which 19 had significant peripheral nonperfusion. Deep capillary plexus FD, VD, and LAC were associated with significant ischemia. In fact, regarding the association with this outcome, LAC alone had the highest area under the curve (AUC = 0.88) followed by FD (AUC = 0.85) and VD (AUC = 0.73). The multivariable model that included LAC and VD, adjusted by best-corrected visual acuity (BCVA) achieved the best performance for the identification of severe nonperfusion on wide-field FA (AUC = 0.93). Conclusions: The characteristics of the central macular deep capillary plexus on OCT-A may be associated with peripheral nonperfusion on FA, particularly the combination of LAC and vessel density after adjusting by BCVA. Translational Relevance: Fractal-based metrics applied to OCT-A may become a valuable marker of ischemia in RVO and help guide the clinical decision to perform invasive angiography. publishersversion published

PURPOSE To establish a normative database for vascular density (VD) and foveal avascular zone (FAZ) at the superficial (SCP) and deep capillary plexus (DCP) in healthy subjects with optical coherence tomography (OCT) angiography. METHODS The study was a retrospective chart review of healthy patients who had undergone OCT angiography imaging. A 3- × 3-mm area, centered on the fovea, was scanned for all the study eyes. The automated segmentation allowed separate analysis of the SCP, the DCP, and a comprehensive C-scan including both vascular layers. On the obtained images, VD and FAZ measurements were computed. Interobserver reproducibility and intraobserver repeatability were also assessed. RESULTS A total of 135 eyes of 70 subjects (51% male) were analyzed. The mean age was 48.3 ± 17.5. We divided patients into group 1, from 20 to 39 years of age; group 2, from 40 to 59 years; and group 3, age 60 years or older. At the level of the SCP, mean VD and mean FAZ ± SD were, respectively, 52.58 ± 3.22% and 0.28 ± 0.1 mm2. At the level of the DCP, mean VD and mean FAZ were 57.87 ± 2.82% and 0.37 ± 0.12 mm2, respectively. The mean VD was significantly higher (P < 0.05) in DCP compared with SCP in all Early Treatment Diabetic Retinopathy Study (ETDRS) sectors and in all age groups. Vascular density was higher in women than in men after 60 years (P < 0.01). After adjustment on the signal strength index (SSI), the mean VD remained directly correlated with the age range and sex. The mean FAZ area was lower in group 3 (P < 0.05). Interobserver reproducibility was 0.78 to 0.99 in SCP and 0.67 to 0.92 in DCP, and intraobserver repeatability was 0.64 to 0.93 in SCP and 0.63 to 0.87 in DCP. CONCLUSIONS Our study has provided, for the first time, age-related VD mapping data using OCT angiography in healthy subjects. The prototype software used in this study may help to improve the concept of VD grading with high inter- and intraexaminer repeatability and interexaminer reproducibility.

Objectif Evaluer les modalites d’utilisation et l’efficacite en vie reelle du traitement par injection intravitreenne (IVT) de ranibizumab chez des patients presentant une baisse de l’acuite visuelle (BAV) due a un œdeme maculaire secondaire a une occlusion veineuse retinienne (OM-OVR) qu’elle soit de branche (B) ou centrale (C), a la demande de la Haute Autorite de sante. Methode Etude de cohorte observationnelle nationale de patients initiant un traitement par IVT de ranibizumab pour une BAV due a un OM-OVR, inclus et suivis pendant 24 mois par des retinologues. Le critere principal d’evaluation est la variation de la Meilleure acuite visuelle corrigee (MAVC) a six mois par rapport a l’inclusion. Les criteres secondaires sont la variation de la MAVC, celle de l’epaisseur de la zone centrale de la retine (ECR), la description des modalites du suivi ophtalmologique et les evenements indesirables au cours des 24 mois de suivi. Resultats Entre decembre 2013 et avril 2015, pour les cohortes B/C, 226/196 patients ont ete inclus dans l’etude et 162/139 (71,7/70,9 %) presentaient des donnees de suivi analysables a 24 mois. Les caracteristiques des patients etaient un âge moyen (e-t) de 70,9 ans (11,1)/70,4 (14,3) ans avec 48,7/51,5 % d’hommes, une MAVC moyenne a l’inclusion de 55,2 ans (18,7)/40,4 (25,6) lettres ETDRS et une ECR moyenne de 550 (175)/643 (217) μm. A 6 (± 1,5) mois de suivi, la variation moyenne de la MAVC [IC 95 %] par rapport a l’inclusion etait de +14,1 [11,7 a 16,5]/ + 9,5 [5,5 a 13,5] lettres. Cette evolution se stabilisait au cours du temps avec +13,0 [10,2 a 15,9]/ + 9,2 [4,5 a 13,9] lettres a 12 (± 1,5) mois et +11,4 [7,7 a 15,2]/ + 8,3 [3,7 a 12,8] lettres a 24 (± 1,5) mois, avec 53,1/38,9 % des patients presentant une MAVC superieure a 70 lettres. La variation moyenne de l’ECR etait de −223 [−254 a −192]/−267 [−314 a −220] μm a 6 (±1,5) mois, −225 [−260 a −191]/−284 [−334 a −233] μm a 12 (±1,5) mois et −211 [−251 a −170]/−305 [−356 a −255] μm a 24 (±1,5) mois. A 24 mois, le nombre moyen d’IVT etait de 7,2 (4,3)/7,1 (4,4) par œil etudie et 85,8/85,6 % des yeux etudies ont eu au moins une interruption des IVT de ranibizumab (72,6/62,5 % pour amelioration de la pathologie et 15,2/26,7 % pour manque d’efficacite). A 24 mois, 69,8/62,6 % des yeux etudies ont recu seulement un traitement par ranibizumab et 30,2/37,4 % un autre traitement intravitreen (premier switch : 15,4/12,2 % par dexamethasone, 13,6/20,9 % par aflibercept, 1,2/0 % par triamcinolone et 0/4,3 % par bevacizumab). Aucun nouveau signal de pharmacovigilance n’a ete detecte. Conclusion Les resultats obtenus en vie reelle a 24 mois chez des patients initiant un traitement par IVT de ranibizumab dans l’OM-OVR montrent une relative stabilite par rapport a ceux observes a six mois. Ces resultats sont un peu plus faibles que ceux des essais cliniques a 24 mois avec une intensite plus faible d’injections en vie reelle (7,2/7,1 dans BOREAL contre 11,4/13,1 dans BRIGHTER/CRYSTAL).

Purpose: Diabetic macular edema (DME) is the leading cause of visual impairment (VI) in patients with diabetes. With the introduction of anti-vascular endothelial growth factor (anti-VEGF) agents, management of DME has evolved. The aim of this study was to identify the routine practice for the management of patients with VI due to DME (best-corrected visual acuity [BCVA] ≤ 20/40) in France in 2014. Methods: The cross-sectional, observational BOREAL DME study was conducted in a real-life practice in France on request of health authority. The study included patients with Type 1 or 2 diabetes aged ≥ 18 years who had a reduction in BCVA due to DME ( ≤ 20/40) irrespective of treatment prescribed at inclusion (including monitoring alone). The following medical data were collected from patients’ medical files: general patient characteristics, disease characteristics (including diabetes and DME), previous treatment for VI due to DME, and treatment prescribed at inclusion. Results: Of the 1023 screened patients, 918 were included in the study (Figure 1). The mean age of the patients was 67.0 years with an average 18.9 years of diabetes; 53.1% were male and 67.3% had bilateral DME (Table 1). For this analysis we included 1321 eyes with VI due to DME (BCVA ≤ 20/40; Figure 1). The majority of eyes (64.6%) had received prior treatment for reduction in BCVA due to DME. In the analyzed eyes, anti-VEGF (49.6%) was the most frequently prescribed treatment at inclusion followed by monitoring alone (41.1%). 65.9% of eyes with monitoring alone had received prior treatment. Corticosteroids were prescribed for 6.5% of eyes, while only 2.2% of eyes received laser. The mean BCVA and central retinal thickness were 53.5 letters and 415 μ m, respectively. Overall, 57.8% of eyes presented non-proliferative DR. In the treatment naïve eyes (n=459), 50.5% received ranibizumab, 40.5% had monitoring alone, and 3.9% each received laser and corticosteroids, respectively. Conclusions: The BOREAL DME study findings suggest that, in real-life practice in France, anti-VEGFs, primarily ranibizumab 0.5 mg, are the primary treatment for VI due to DME, followed by monitoring alone in 2014. Macular laser is currently rarely used in the French population.

PURPOSE. To compare macular choroidal thickness (MCT) in eyes with adult onset foveomacular vitelliform dystrophy (AOFVD) and eyes with AMD. METHODS. Five groups of 38 eyes each were included in a prospective, observational, comparative study: AOFVD eyes with fluid accumulation; AOFVD fellow eyes without fluid (early stage); advanced exudative (wet) AMD; advanced dry AMD; and healthy normal eyes. All study eyes underwent a comprehensive ophthalmologic examination. Macular choroidal thickness was measured using enhanced depth imaging optical coherence tomography (EDI-OCT). RESULTS. Subfoveal choroidal thickness (SFCT) in AOFVD with subretinal fluid (325.66 +/- 85.98 mu m) was significantly (P < 0.001) thicker compared with that in exudative AMD (158.55 +/- 57.87 mu m) and in dry AMD (157.53 +/- 67.08 mu m). Also, in AOFVD, the choroid was significantly (P = 0.001) thicker than that in the normal group (255.87 +/- 87.46 mu m). However, in AOFVD, there was no significant difference (P = 0.69) between the SFCT in the study eye and in the fellow eye (317.66 +/- 90.04 mu m). The choroidal thickness at each of the other 12 measured points showed similar results. CONCLUSIONS. This study demonstrates choroidal thickening in AOFVD in contrast with the choroidal thinning observed in advanced AMD. These findings suggest that the pathogenic mechanisms in AOFVD are different from those in exudative AMD. Choroidal thickness measurement could help differentiate the challenging diagnosis between exudative AMD and the advanced stage of AOFVD (with fluid accumulation but without choroidal neovascularization).

Background Our purpose was to describe the different morphological features in adult onset foveomacular vitelliform dystrophy (AOFVD), using en face enhanced depth imaging (EDI) spectral-domain optical coherence tomography (SD-OCT). Methods Thirty eyes of 22 consecutive patients presenting with diagnosis of AOFVD were enrolled. Diagnosis of AOFVD was concluded based on fundus examination, autofluorescence imaging, fluorescein angiography and SD-OCT. En face OCT imaging was obtained with the Spectralis EDI SD-OCT; 97 inverted sections (nine averaged B-scans per image) were acquired. Results On en face OCT, vitelliform lesions appeared as regular concentric rings of different reflectivity. From the periphery to center of the ring, we observed: (1) the hypereflective ring representing the inner segment/outer segment (IS/OS) junction, which was continuous in 23 out of 30 eyes, and (2) a well-detectable hyporeflective ring between the IS/OS junction and vitelliform material in 20 out of 30 eyes; the innermost composant of the lesion was hypereflective, and it corresponded to vitelliform material. In eight out of 30 eyes, a hyporeflective "croissant"-shaped lesion with inferior concavity in the upper part of the hyperreflective material was present. Hypereflective retinal pigment epithelium (RPE) elevations or bumps were detected in 25 out of 30 eyes. These areas of focal RPE thickening or bumps appeared to be intensely hypereflective on infrared reflectance imaging. Conclusion En face imaging of the retina helps visualizing the distribution of vitelliform material in AOFVD. The sedimentation of vitelliform lesions is characterized by a upper "croissant"-shaped hypoflectivity. The bumps/thickening of RPE appeared as hypereflective lesions on IR imaging.

Introduction. - Myopic choroidal neovascularization (CNV) is the first cause of CNV in young patients. The aim of this study was to compare the efficacy of intravitreal injections (IVT) of ranibizumab with photodynamic therapy (PDT) in this indication. Patients and methods. - Retrospective comparative study analyzing the visual acuity (VA) outcomes of CNV myopic patients treated with either IVT or PDT. Results. - Twenty-seven eyes of 25 patients were treated with PDT (group 1) and 18 eyes of 17 patients were treated with IVT of ranibizumab (group 2). Demographic data were similar in the two groups. The median initial VA was 20/80 for group 1 and 20/160 for group 2 (P = 0.37). At 1 year, the median VA was 20/80 for group 1 (P = 0.32) and 20/63 for group 2 (P = 0.04). A significant improvement in VA was observed in 23.1% and in 27.3% of cases in groups 1 and 2, respectively (P = 0.53). A significant VA worsening was observed in 34.6% of cases in group 1 and in 9.1% of cases in group 2 (P = 0.21). Conclusion. - IVT of ranibizumab compared to PDT treatment showed greater efficacy in this study. (C) 2011 Elsevier Masson SAS. All rights reserved.

Purpose: The purpose of this study was to evaluate the efficacy of intravitreal injections of ranibizumab in choroidal neovascularization secondary to pathologic myopia. Methods: A prospective case series of 32 eyes of 32 patients affected with choroidal neovascularization secondary to pathologic myopia treated by intravitreal injections of ranibizumab. Best-corrected visual acuity, fundus examination, fluorescein angiography, indocyanine green angiography, and spectral domain-optical coherence tomography were performed for the diagnosis of myopic choroidal neovascularization. Best-corrected visual acuity and central retinal thickness measurement were performed monthly during the follow-up. Results: The median number of injections was 3 with a median follow-up of 17 months. The median visual acuity at baseline was 20/100 and improved to 20/50 at final examination (P < 0.0001). Best-corrected visual acuity improved by >= 3 lines in 15 of 32 eyes (46.8%). The median central thickness was 336 mu m (range, 179-663 mu m) at baseline and 233 mu m (range, 125-465 mu m) at final examination (P < 0.0001). No severe drug-related side effect was reported. Conclusion: In our series of myopic choroidal neovascularization, intravitreal injections of ranibizumab showed visual acuity improvement and retinal thickness reduction. Further prospective multicentric clinical trials are needed to evaluate the safety and the efficacy of this treatment. RETINA 30: 399-406, 2010

Objectif Evaluer les modalites d’utilisation et l’efficacite en vie reelle du traitement par injection intravitreenne (IVT) de ranibizumab chez des patients presentant une baisse de l’acuite visuelle (BAV) due a un œdeme maculaire secondaire a une occlusion veineuse retinienne (OM-OVR) qu’elle soit de branche (B) ou centrale (C), a la demande de la Haute Autorite de sante (HAS). Methode Etude de cohorte observationnelle nationale de patients initiant un traitement par IVT de ranibizumab pour une BAV due a un OM-OVR (320 patients attendus par pathologie, pour avoir une precision de ± 2 lettres), inclus et suivis pendant 24 mois par des ophtalmologistes specialistes de la retine (retinologues). Le critere principal d’evaluation est la variation de la meilleure acuite visuelle corrigee (MAVC) a six mois par rapport a l’inclusion. Les criteres secondaires sont la variation de la MAVC, celle de l’epaisseur de la zone centrale de la retine (ECR), la description des modalites du suivi ophtalmologique ainsi que les evenements indesirables au cours du suivi. Resultats Entre decembre 2013 et avril 2015, pour les cohortes B/C, 223/196 patients ont ete inclus dans l’etude et 207/180 (92,8/91,8 %) presentaient des donnees de suivi analysables a six mois. Les caracteristiques des patients etaient un âge moyen (ET) de 70,3 (11,1)/70,5 (14,4) ans avec 47,8/50,6 % d’hommes, des premiers symptomes apparus en moyenne depuis 4,4 (12,6)/3,0 (6,0) mois, 9,2/8,3 % des patients deja traites pour leur OM-OVR (4,8/0,0 % par laser maculaire, 6,3/7,8 % par corticotherapie intravitreenne, 1,0/1,1 % par un autre anti-VEGF), et 3,9/2,8 % avec une atteinte bilaterale. A l’inclusion, la MAVC moyenne etait de 54,7 (18,9)/40,5 (25,7) lettres d’ETDRS avec 13,5/8,3 % des patients qui presentaient une MAVC superieure a 70 lettres. L’ECR moyenne etait de 558 (178)/649 (216) μm. Au cours des trois premiers mois, 80,7/76,1 % des patients avaient recu les trois IVT recommandees (traitement d’induction). A 3 (± 1,0) mois de suivi, la variation moyenne de la MAVC [IC 95 %] par rapport a l’inclusion etait de 14,7 [12,4 a 17,1]/16,0 [12,1 a 19,8] lettres et l’evolution de l’ECR etait de −240 [−269 a −211]/−323 [−371 a −275] μm. A six mois de suivi, le nombre moyen d’IVT etait de 3,8 (1,2)/3,6 (1,2) par œil etudie et 59,4/56,1 % des patients avaient eu au moins une interruption des IVT de ranibizumab (52,7/38,3 % pour amelioration de la pathologie et 7,2/15,6 % pour manque d’efficacite). A 6 (± 1,5) mois de suivi, la variation moyenne de la MAVC par rapport a l’inclusion etait de 13,9 [11,5 a 16,3]/9,5 [5,5 a 13,5] lettres avec 43,5/30,6 % des patients presentant une MAVC superieure 70 lettres. En parallele, l’evolution de l’ECR etait de −223 [−254 a −192]/−264 [−311 a −217] μm. Conclusion Cette etude en vie reelle chez des patients initiant un traitement par IVT de ranibizumab dans l’OM-OVR montre une amelioration de l’acuite visuelle a trois mois proche de celle des essais cliniques pre-AMM (BRAVO/CRUISE), et un peu plus faible a six mois mais avec une intensite plus faible d’injections en vie reelle (3,8/3,6 dans BOREAL contre 6 dans BRAVO/CRUISE).

Although central retinal vein occlusion (CRVO) accounts for a minority of retinal vein occlusions, it is associated with more severe vision loss and with the vision-threatening risk of neovascular glaucoma. The newly available treatments for macular edema have considerably improved visual outcome of many CRVO patients. Nevertheless, the evaluation of the ischemic component remains essential. The presentation will include when to perform laboratory workup for systemic disease and how macular edema treatment could be combined with classical treatment (etiologic treatment such as hemodilution, treatment of non-perfusion area with laser photocoagulation). Commercial interest

Purpose To study the functional results of macular surgery and determine pre-operative features associated with better final visual outcome. Methods Forty-two consecutive patients underwent surgical removal of subfoveal choroidal neovascularization (CNV), related to age-related macular degeneration (AMD) in 8 eyes, degenerative myopia in 14 eyes, multifocal choroiditis (MFC) in 10 eyes, idiopathic CNV in 6 eyes and other etiologies in 4 eyes. Mean age was 49 years. Pre-operative visual acuity (VA) was 20/200 or less in 30 eyes (71.4%) and never better than 20/40. Fluorescein angiography was analyzed before and after surgery. Pre-operative optical coherence tomographs (OCT) were studied in a masked fashion. Mean follow-up was 12 months (range 4–48 months). Results Final VA was 20/200 or less in 25 eyes (60%). According to the CNV etiology, the percentage were 87.5%, 80%, 57.1% and 20% respectively in eyes with AMD, MFC, high myopia, and idiopathic or other diseases. Post-operative VA improved in 21 eyes (50%) but subsequently declined in 7% by the final examination. Patients younger than 50 years had better functional results (p=0.006). Lack of retinal pigment epithelium (RPE) changes on pre-operative angiography was correlated with good visual outcome (pConclusions CNV surgical excision results vary depending on the underlying disease, the RPE and choriocapillaris function, and the features observed on pre-operative OCT images.

Objective: To evaluate the safety and efficacy of 1 or 2 treatments with dexamethasone intravitreal implant (DEX implant) over 12 months in eyes with macular edema owing to branch or central retinal vein occlusion (BRVO or CRVO). Design: Two identical, multicenter, prospective studies included a randomized, 6-month, double-masked, sham-controlled phase followed by a 6-month open-label extension. Participants: We included 1256 patients with vision loss owing to macular edema associated with BRVO or CRVO. Methods: At baseline, patients received DEX implant 0.7 mg (n = 421), DEX implant 0.35 mg (n = 412), or sham (n = 423) in the study eye. At day 180, patients could receive DEX implant 0.7 mg if best-corrected visual acuity (BCVA) was 250 mu m. Main Outcome Measures: The primary outcome for the open-label extension was safety; BCVA was also evaluated. Results: At day 180, 997 patients received open-label DEX implant. Except for cataract, the incidence of ocular adverse events was similar in patients who received their first or second DEX implant. Over 12 months, cataract progression occurred in 90 of 302 phakic eyes (29.8%) that received 2 DEX implant 0.7 mg injections versus 5 of 88 sham-treated phakic eyes (5.7%); cataract surgery was performed in 4 of 302 (1.3%) and 1 of 88 (1.1%) eyes, respectively. In the group receiving two 0.7-mg DEX implants (n = 341), a >= 10-mmHg intraocular pressure (IOP) increase from baseline was observed in (12.6% after the first treatment, and 15.4% after the second). The IOP increases were usually transient and controlled with medication or observation; an additional 10.3% of patients initiated IOP-lowering medications after the second treatment. A >= 15-letter improvement in BCVA from baseline was achieved by 30% and 32% of patients 60 days after the first and second DEX implant, respectively. Conclusions: Among patients with macular edema owing to BRVO or CRVO, single and repeated treatment with DEX implant had a favorable safety profile over 12 months. In patients who qualified for and received 2 DEX implant injections, the efficacy and safety of the 2 implants were similar with the exception of cataract progression. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. Ophthalmology 2011; 118: 2453-2460 (C) 2011 by the American Academy of Ophthalmology.

CASE REPORT. A 31-year-old woman complained of blurred vision in the right eye due to a well-perfused central retinal vein occlusion (CRVO) and two months later, of sudden deafness (SD) in her right ear. Her visual acuity and hearing recovered almost completely within a few months. Medical evaluation disclosed the combination of slight coagulation abnormalities (moderate decrease in protein S, slightly elevated lipoprotein (a)), and elevated fibrinogen, with plasma hyperviscosity. DISCUSSION. The occurrence of CRVO then SD suggests that the same underlying conditions can be considered as risk factors for both diseases and shows up some similarities in the pathogenesis of these acute impairments of microvascular blood flow in the retina and the cochlea. (Eur J Ophthalmol 2001; 11: 197-9)

Objective: To evaluate the safety and efficacy of dexamethasone intravitreal implant (DEX implant; OZURDEX, Allergan, Inc., Irvine, CA) compared with sham in eyes with vision loss due to macular edema (ME) associated with branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO). Design: Two identical, multicenter, masked, randomized, 6-month, sham-controlled clinical trials (each of which included patients with BRVO and patients with CRVO). Participants: A total of 1267 patients with vision loss due to ME associated with BRVO or CRVO. Intervention: A single treatment with DEX implant 0.7 mg (n = 427), DEX implant 0.35 mg (n = 414), or sham (n = 426). Main Outcome Measures: The primary outcome measure for the pooled data from the 2 studies was time to achieve a >= 15-letter improvement in best-corrected visual acuity (BCVA). Secondary end points included BCVA, central retinal thickness, and safety. Results: After a single administration, the time to achieve a >= 15-letter improvement in BCVA was significantly less in both DEX implant groups compared with sham (P= 15-letter improvement in BCVA was significantly higher in both DEX implant groups compared with sham at days 30 to 90 (P= 15-letter loss in BCVA was significantly lower in the DEX implant 0.7-mg group compared with sham at all follow-up visits (P 25 mmHg peaked at 16% at day 60 (both doses) and was not different from sham by day 180. There was no significant between-group difference in the occurrence of cataract or cataract surgery. Conclusions: Dexamethasone intravitreal implant can both reduce the risk of vision loss and improve the speed and incidence of visual improvement in eyes with ME secondary to BRVO or CRVO and may be a useful therapeutic option for eyes with these conditions.

Purpose To measure the retinal thickness in the macular area and at the typical fundus spots in a patient with birdshot retinochoroidopathy, using the retinal thickness analyzer (RTA), a new image analyzer involving laser-slit biomicroscopy, and to quantify the changes after systemic corticosteroid therapy. Case Report A 54-year-old man with posterior uveitis underwent visual acuity measurement, fluorescein and indocyanine green (ICG) angiographies, optical coherence tomography (OCT) and RTA measurements before and after steroid treatment. Results The thickness at the birdshot spots measured with RTA remained unchanged after treatment, but the thickness at the fovea decreased in both eyes. Fluorescein and ICG angiographies and OCT showed no change with treatment. Conclusions RTA seems a more sensitive method for assessing changes in macula thickness in the course of birdshot retinochoroidopathy and can help document the effect of treatment.

PURPOSE. To evaluate the use of infracyanine green (IFCG) staining in idiopathic epiretinal membrane (ERM) surgery. METHODS. A retrospective comparative study of 63 consecutive eyes with ERM operated on with internal limiting membrane (ILM) peeling using or not filtered IFCG diluted (5:1) in glucose 5%. Main outcome measures were best-corrected visual acuity, central visual field perimetry, fluorescein angiography with blue light fundus photograph, optical coherence tomography (OCT), and in seven eyes multifocal electroretinogram (mfERG). RESULTS. A total of 44 eyes underwent surgery with ILM staining using IFCG and 19 eyes without. In the IFCG group, the staining showed that the ILM was removed together with the ERM in 39% of eyes; ILM was still present on the macula after ERM removal in 57% of eyes and removed secondarily. The improvement in vision was slightly better in the IFCG group throughout follow-up but the difference was not significant. On the postoperative blue light photograph, defects in the optic nerve fibre layer were less frequent in the group with IFCG than without (p=0.023), suggesting less peroperative trauma. Two eyes in the group operated without IFCG had recurrence of the ERM including one with a macular hole vs none in the group with IFCG. No difference was observed in the groups as regards central visual field testing, mfERG, OCT, or angiographic data. CONCLUSIONS. Using IFCG for ILM peeling in ERM surgery seemed to reduce significantly the trauma to the optic nerve fiber layer and to prevent ERM recurrence. Deleterious effects were not observed in this study. (Eur J Ophthalmol 2008; 18: 972-9)

PURPOSE. To evaluate quantitatively the effect of grid laser photocoagulation in macular edema due to central and branch retinal vein occlusion, using the retinal thickness analyzer. METHODS. Five patients with cystoid and non-cystoid macular edema were studied before and after argon grid laser treatment. All were examined clinically, with fluorescein angiography, and measurement of retinal thickness. Macular thickness was correlated to visual acuity measured on the ETDRS chart. RESULTS. Laser-slit images obtained with the retinal thickness analyzer in patients with macular edema disclosed discrete intraretinal changes after photocoagulation. Biomicroscopy and fluorescein angiography were insensitive to these small changes in the retinal thickness. No patient had any change in visual acuity after three months, but the retinal thickness was greater at this interval. The retinal thickening may be explained by a postoperative inflammatory response or by altered retinal blood flow or, in two of the eyes, by the effect of combined peripheral photocoagulation. CONCLUSIONS. The retinal thickness analyzer offers a refined tool for the diagnosis of subclinical changes of macular edema in retinal vein occlusion and is therefore also useful for assessing the effects of treatment.

Aims—To study the eVects of intravitreal tissue plasminogen activator (tPA) in recent onset central retinal vein occlusion (CRVO). Methods—15 patients with recent onset CRVO (from 1‐21 days’ duration, mean 8 days) were given 75‐100 µg of tPA intravitreally associate with low dose low molecular weight heparin. CRVO was perfused in nine patients and with mild ischaemia not exceeding 100 disc diameters in six patients. Follow up ranged from 5 to 21 months for 14 patients (mean 8 months). Visual acuity measurement, macular threshold (Humphrey perimeter), fluorescein angiography with the scanning laser ophthalmoscope with special emphasis on retinal circulation times, and retinal perfusion were performed at days 0, 1, and 8 and months 1, 3, and 6. Results—Visual acuity was significantly improved on the first day after treatment in only one eye, and decreased transiently in six eyes (40%). Retinal blood velocity was not significantly modified by tPA injection. Retinal ischaemia developed in six eyes (43%), leading to panretinal photocoagulation in five eyes including one with rubeosis iridis. At the end of follow up, visual acuity had improved to 20/30 or better in five eyes (36%),including two with complete recovery; visual acuity was worse than 20/200 in three eyes (28%). No complication of tPA injection was observed. Conclusion—Intravitreal tPA treatment for CRVO appears to be simple and safe, but did not significantly modify the course of the occlusion in our patients immediately after treatment. Final visual outcome did not diVer significantly from that observed in the natural course of the disease, but final visual acuity seemed to be slightly better. A randomised study is required to determine if intravitreal tPA actually improves visual outcome in CRVO. (Br J Ophthalmol 2000;84:609‐613)

Basal laminar drusen (BLD) are small round yellow drusen that are more easily visualised angiographically than biomicroscopically, with a 'stars in the sky' pattern. Patients with BLD are predisposed to macular vitelliform detachment. Little is known about the course of the disease, but the prognosis for retention of useful central vision for patients with BLD is thought to be better than for patients with typical drusen. A retrospective analysis of clinical and angiographic charts of 19 patients with BLD combined with a vitelliform macular detachment was performed to precisely describe their course. In addition, nine patients were re-examined to allow an analysis of their visual function--that is, central visual field, contrast sensitivity, and colour vision. Eyes without choroidal new vessels retained a fair visual acuity (mean final visual acuity 0.5; follow up 4 to 69 months, mean 24 months). In 11 of these eyes visual function assessment disclosed a reduction of contrast sensitivity in high and medium spatial frequencies in nine eyes (81%), a blue-yellow dyschromatopsia in nine eyes (81%), and a mild reduction of foveal threshold in seven eyes (63%). Choroidal neovascularisation (CNV) was observed in 12 eyes (31%) with a poor final outcome (mean final visual acuity 0.1). Two thirds of cases of CNV were observed at the time of presentation; thus this finding may be a bias of a referring centre. However, the high prevalence of CNV suggests the need for a close follow up of patients with BLD.

To evaluate the possible involvement of obstructive sleep apnea (OSA) in retinal vein occlusion (RVO).From the medical records of 63 consecutive patients with RVO, 30 patients with 2 of the 3 following risk factors for OSA were selected for further screening from February 1, 2008, through March 31, 2009: associated cardiovascular disease, snoring, or daytime sleepiness.Of the 30 selected patients, 23 (77%) had OSA. If all 33 of the unscreened patients did not have OSA, the OSA prevalence would have been 37%. Among the patients with OSA, the mean apnea-hypopnea index (AHI) was 21; OSA was mild (AHI15) in 13 patients, moderate in 5 patients (AHI 15-30), and severe (AHI30) in 5 patients. The AHI was correlated with body mass index (P = .02).We found a higher than expected prevalence of OSA in a series of patients with RVO. Our findings suggest that OSA could be an additional risk factor that plays an important role in the pathogenesis of RVO or at least that it is a frequently associated condition that could be a triggering factor. This association may explain why most patients discover visual loss on awakening. It is too early to assess whether OSA treatment could improve visual outcome of RVO, but it seems vital to recognize OSA in RVO for the general health of the patient.