Search

Harold Merle,1 Laurence Béral,2 Maxime Rocher,3 Mitta Pierre,1 Albert Jean-Charles,1 Odile Béra,4 Laurie-Anne Rosamont,4 Pierre-Yves Robert,3 Agnes Lézin4 1Department of Ophthalmology, University Hospital of Martinique, Fort de France, French West Indies, France; 2Department of Ophthalmology, University Hospital of Guadeloupe, Pointe à Pitre, French West Indies, France; 3Department of Ophthalmology, University Hospital of Limoges, France; 4Department of Genetics, University Hospital of Martinique, Fort de France, French West Indies, FranceCorrespondence: Harold Merle, Department of Ophthalmology, University Hospital of Martinique, Hôpital Pierre Zobda Quitman, BP 632, Martinique, Fort de France, 97261 Cedex, French West Indies, France, Tel +596 596 552 251, Fax +596 596 758 447, Email harold.merle@chu-martinique.frPurpose: To evaluate how the HLA genotype is associated to the polypoidal choroidal vasculopathy (PCV) in a population of patients of Afro-Caribbean descent.Methods: Forty-seven patients were diagnosed with PCV. The number of control patients was 457. All affected patients and control patients were of Afro-Caribbean descent and natives to Martinique. HLA typing was based on blood sample, using the polymerase chain reaction technique. Comparison of HLA alleles between the 2 groups was done using chi-2 test, odds ratio (OR) and confidence interval using Woolf’s method. The Bonferroni correction was considered significant when p-value ≤ 0.05. Alleles frequency was analyzed for DRB1 and DQB1 locus.Results: HLA-DRB1&ast;13 allele was significantly associated to PCV (OR = 2.02, CI = [1.3; 3.13], p = 0.003). In group DRB1, the Bonferroni correction significance threshold was < 0.004. HLA-DQB1&ast;04 allele was significantly associated to PCV (OR = 3.5, CI = [1.48; 8.3], p = 0.006). In group DQB1, the Bonferroni correction significance threshold was < 0.006.Conclusion: Two HLA alleles are positively associated to PCV. The possible association between PCV and certain alleles suggest HLA implication in PCV pathogeny, most likely by modeling the immune system response.Keywords: polypoidal choroidal vasculopathy, major histocompatibility complex, human leucocyte antigen, genetic predisposition

Background: Cytomegalovirus (CMV) can cause a wide panel of ocular infections. The involvement of CMV as a cause of anterior uveitis in the immunocompetent patient is recent and remains poorly understood., Objective: To investigate the presence of CMV in anterior uveal tissues of immunocompetent corneal donors., Study Design: We collected aqueous humor, iris, and ciliary body from both eyes of 25 donors died at the Limoges University Hospital between January 2020 and July 2021. CMV serology was determined for all patients from post-mortem blood sample. Ocular tissues were split in 2 fragments for qPCR and 2 for histological analysis. CMV genomes copies were quantified by Multiplex qPCR after DNA extraction., Results: 16 of 25 patients (64%) displayed positive CMV serology, with a median age of 67 years. Viremia was positive in 3 of 16 (19%) CMV-positive patients. No CMV DNA copies were found from the aqueous humor samples. CMV DNA was detected in iris and ciliary body of 28 of 32 eyes of seropositive donors, and 5 of 18 eyes of seronegative donors. The median viral copy number [IQR] was 2.41 × 10 2 [8.91 × 10 1 - 1.01 × 10 3 ] copies/1 × 10 6 cells in the CMV-positive group and 0.00 [0.00 - 3.54 × 10 2 ] copies/1 × 10 6 cells in the CMV-negative group (p<0.001). Histology and immunohistochemistry did not reveal any CMV lesions from any sample., Conclusion: CMV DNA was found in iris and ciliary body of immunocompetent seropositive patients, but also, although less frequently, from seronegative donors. These results highlight mechanisms of infection, latency and reactivation of CMV in ocular tissues., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Purpose: To report a case of large full thickness macular hole (MH) as an uncommon complication of an idiopathic retinal vasoproliferative tumor (RPVT) and the successful closure of the full-thickness MH by the inverted internal limiting membrane Flap technique., Methods: A case report. A 40-year-old woman was referred for a progressive and profound visual loss on the right eye. The fundus examination showed a full-thickness MH and the presence of an idiopathic RPVT surrounding by numerous exudates in the inferior temporal of the peripheral retina. In addition, the spectral domain optical coherence tomography imaging confirmed the large size of the full-thickness MH (740 μ m-diameter). First, we treated the RPVT using the transconjunctival cryotherapy. Then, we performed the macular surgery including 25 Gauge vitrectomy, inverted internal limiting membrane flap technique, and gas tamponade., Results: In the postoperative period, the RPVT remained inactive with no recurrence of the MH or excessive gliosis proliferation on the internal limiting membrane flap area. Moreover, visual acuity rose up from 20/100 (0.2) at 1-month follow-up to 20/40 (0.5) at 6-month follow-up., Conclusion: In our patient, the full-thickness MH was precisely large and secondary to an RPVT. The treatment of the tumor by transconjunctival cryotherapy had been efficient and the postoperative follow-up after the macular procedure involving the inverted internal limiting membrane flap technique showed the anatomical and functional recovery of the macula.

Purpose: To identify genetic, systemic, and biological factors associated with the occurrence of sickle cell maculopathy (SCM). To evaluate microvascular macular alterations using optical coherence tomography angiography (OCTA) in sickle cell disease (SCD)., Design: Cross-sectional study., Methods: One hundred fifty-one eyes of 78 adult SCD patients (43 HbSS, 30 HbSC, 4 S/β + , and 1 HbS Lepore) and 40 eyes of 20 healthy controls underwent spectral-domain optical coherence tomography (SDOCT) and OCTA using Spectralis HRA+OCT (Heidelberg Engineering, Heidelberg, Germany). We analyzed the occurrence of SCM, the foveal avascular zone (FAZ) area, and the severity of macular ischemia and studied their relationships with genetic, systemic, and biological parameters using multivariate logistic regression analysis., Results: Maculopathy occurred in 66 eyes (44%), and more frequently in HbSS patients (71%, P = .004). Multivariate analysis identified HbSS genotype and lower prothrombin ratio (PR) as independently associated with SCM (P = .01). Proliferative sickle cell retinopathy was also associated with SCM (P = .02). FAZ enlargement was associated with higher lactate dehydrogenase level (P = .02). Macular ischemia was more severe in patients with lower hemoglobin level (P = .004) and lower PR (P = .01). No flow areas were identified with OCTA even in eyes with no macular thinning (36 eyes, 42%) and appeared more frequently in the temporal superior subfield (36%)., Conclusions: HbSS genotype, abnormal coagulation and hemolysis increase the risk of SCM. OCTA provides valuable criteria to identify potential risk factors of SCM. OCTA also improves detection of early microvascular changes before the onset of macular thinning., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Importance: Acute anterior uveitis has been reported to be associated with Zika virus (ZIKV) infection in case reports and retrospective studies based on systemic clinical signs of ZIKV and positive serologic tests., Objective: To describe the ophthalmic findings associated with systemic ZIKV infection during the 2016 ZIKV outbreak in Guadeloupe in the French West Indies., Design, Setting, and Participants: This cohort study assessed adult patients with red eye and virologic or serologic confirmation of acute ZIKV infection who were admitted to the Pointe-à-Pitre University Hospital from January 1, 2016, to January 1, 2017, for a systematic ophthalmologic examination. All patients with anterior uveitis also underwent a complete uveitis workup to rule out other causes of uveitis. Patients were excluded from the study if they had active uveitis and a history of uveitis or positive serology for other infectious diseases including dengue fever virus and chikungunya virus. Data were analyzed from January 1, 2016, to January 1, 2017., Exposures: Patients with confirmed ZIKV infection underwent full ophthalmic examination at study inception and 3, 6, and 12 months., Main Outcomes and Measures: Description of the presenting ocular characteristics, management, and outcome., Results: Of 62 total patients with a red eye, 32 (51.6%) had no uveitis (mean [SD] age, 27.8 [3.7] years; 26 women [81.3%]) and 30 (48.4%) had anterior uveitis (mean [SD] age, 27.5 [3.8] years; 26 women [86.7%]), which was bilateral in all cases. Acute anterior uveitis was nongranulomatous and without synechiae, exhibiting mild anterior chamber reaction with small keratic precipitates. Ocular hypertension occurred in 25 patients (83.3%) with uveitis at presentation and persisted in 15 patients (50%) at 1 year despite antiglaucoma therapy and control of uveitis. Uveitis responded to topical steroids in all cases. Intraocular pressure was within normal limits for all patients without uveitis throughout the follow-up period., Conclusions and Relevance: Anterior uveitis was present in almost half of patients with a red eye and acute systemic ZIKV infection; the uveitis was usually bilateral and often associated with increased intraocular pressure. These results suggest that ophthalmic evaluation should be performed in patients with red eye and acute ZIKV infection to potentially detect and manage hypertensive anterior uveitis.

Background: The aim of the present work was to describe and compare multifocal electroretinogram findings (mfERG) between patients with sickle cell disease (SCD) without clinical sign of maculopathy and controls (HbAA)., Methods: Both HbSS (homozygous SCD) and HbSC (compound heterozygous SCD) patients, the two most frequent SCD genotypes, were included. All individuals underwent a full ophthalmologic examination (with a fundoscopy), a spectral domain ocular coherence tomography (SD-OCT) and a mfERG., Results: A total of 86 subjects were included: 54 SCD patients (107 eyes) with 32 HbSS (63 eyes) and 22 HbSC (44 eyes) and 32 controls (64 eyes). None of the eyes showed retinal clinical abnormalities. SD-OCT analysis showed that macular thickness was statistically lower in SCD eyes than in controls. mfERG analysis demonstrated a significant reduction of N1 (initial-negative deflection), and P1 (positive peak) response amplitude densities of HbSS eyes compared to HbAA eyes from the centre (<2°) and to the periphery (>15°). Implicit time response was also reduced in the centre (<2°). N1 and P1 response amplitude densities of HbSC eyes were significantly lower than those of HbAA eyes from the centre (<2°) to the periphery (>15°). N1 implicit time was statistically reduced in HbSS compared to HbSC eyes., Conclusion: Our study is the first one to describe macular electrophysiological dysfunction in SCD patients. Moreover, we confirm that SCD maculopathy is equally frequent in HbSS and HbSC.

Objective: Our study investigated the prevalence of retinopathy and maculopathy in sickle cell patients and tested the association between these two conditions. In addition, we tested whether hematological and hemorheological parameters, as well as genotype, were involved in the development of these two conditions., Methods: Seventy sickle cell adult patients were recruited: 37 with sickle cell anemia (SCA) and 33 with sickle cell hemoglobin C disease (SCC). All patients underwent retinal examination and macular ocular coherence tomography. Blood was sampled for the measurements of hematological and hemorheological parameters., Results: Twenty-six patients had maculopathy and 30 had retinopathy with no significant difference between SCA and SCC patients. No association between the presence of retinopathy and maculopathy was detected. RBC aggregation was higher and RBC deformability lower at 3 Pa in SCA patients. Blood viscosity and hematocrit were higher in SCC than in SCA patients. However, no association was found between biological parameters and the ocular complications studied., Conclusions: Our study showed that retinopathy and maculopathy are common in sickle cell disease. Nevertheless, we found no association with hematological parameters, blood rheology or genotype.

Purpose: To report a case series of post-phacoemulsification endophthalmitis despite antibiotic prophylaxis with an intracameral injection of a licensed cefuroxime formulation (Aprokam)., Setting: University Hospitals of Pointe-à-Pitre, Guadeloupe, and Fort-de-France, Martinique, French West Indies., Design: Retrospective case series., Methods: Patients who had cataract surgery with licensed cefuroxime prophylaxis between March 1, 2013, and July 31, 2015, and developed endophthalmitis were included. Bacteriologic findings and final corrected distance visual acuity 6 months after treatment were collected., Results: Five patients developed endophthalmitis within 15 days after surgery, which was performed in different settings by different cataract surgeons. All patients had no-stich cataract surgery. Surgery was uneventful in 4 cases. One patient had a posterior capsule rupture. An anterior chamber paracentesis with analysis of the aqueous humor was performed to confirm endophthalmitis. Bacteriologic tests showed α-hemolytic streptococcus in 2 cases, Staphylococcus epidermidis in 1 case, and Serratia marcescens in 1 case. Two strains of bacteria showed cefuroxime resistance on the antibiogram. Despite parenteral and intravitreal injections of antibiotics, 4 of 5 cases had a poor outcome, with a visual acuity of less than 20/200. Retinal detachment (RD) was the most frequent complication observed in the following months., Conclusions: Although licensed cefuroxime has proven to be efficient in reducing the incidence of endophthalmitis, it has not eradicated this potentially severe complication of cataract surgery. Endophthalmitis occurring after the use of licensed cefuroxime can still result in very poor visual outcomes related to the infection itself or to its delayed complications such as RD., Financial Disclosure: None of the authors has a financial or proprietary interest in any material or method mentioned., (Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

A 21-year-old man with Kenny-Caffey syndrome had been observed since 1993 for hyperopia. Fundus examination revealed swollen optic disks. Further examinations (fluorescein angiography, B-scan ultrasonography, and optical coherence tomography) confirmed the optic nerve head elevation. The authors report a rare case of Kenny-Caffey syndrome with extreme pseudopapilledema. Although uncommon, ophthalmologists should be mindful of this disorder when a patient presents with characteristic findings because severe electrolyte disturbances may complicate the clinical course., (Copyright 2009, SLACK Incorporated.)

Purpose: To determine the characteristics of infectious keratitis related to plano cosmetic lenses., Methods: Retrospective case study of a series of infectious keratitis among plano cosmetic lenses wearers. The main parameters were demographic data, medical history, risk factors for infectious complications and keratitis severity criteria, microbiological results, clinical course, and final visual acuity., Results: Five patients were included, all females, ranging from 15 to 50 years of age. Four were emmetropic. One patient had undergone refractive photokeratectomy a few months before. All had risk factors for infectious complications. The fundamental causes of infections were diverse: bacterial abscesses, keratomycosis, and amoebic keratitis. All presented severity criteria. In two cases, the keratitis led to severe consequences with legal blindness requiring penetrating keratoplasty in one case., Discussion: Infectious keratitis in plano cosmetic lenses wearers is not rare and may have dramatic consequences. Sales are specifically regulated and the lenses are considered cosmetic products, not medical devices. The sales regulations for plano cosmetic lenses should be updated, as several countries have already done after encountering many serious incidents., (Copyright 2010 Elsevier Masson SAS. All rights reserved.)

Purpose: To measure peripapillary retinal nerve fiber layer (RNFL) thickness and spatial and temporal contrast sensitivity in multiple sclerosis (MS) taking into account previous history of optic neuropathy (ON)., Methods: Thirty patients (60 eyes) with relapsing-remitting MS were selected (MS group). The MS ON group was composed of 31 eyes with previous history of optic neuropathy and the MS non-ON group of 29 eyes was without previous history of optic neuropathy. Thickness of the RNFL was measured with optical coherence tomography (OCT) with the Stratus OCT. As for sensitivity to spatial contrast,we used Pelli-Robson and Sloan charts. Sensitivity to temporal contrast was explored using frequency doubling technology perimetry (FDTP)., Results: The average thickness of RNFL in the MS, MS ON, MS non-ON, and control groups were 88.2 +/= 18.9 microm, 80.81 +/- 18.4 microm, 96.7 +/- 15.8 microm, and 106 +/- 12.2 microm, respectively. The spatial contrast vision and FDTP results were less in the MS non-ON group than in the control group. The average thickness of RNFL correlated to the scores of spatial and temporal contrast vision., Conclusions: MS is accompanied by visual function alteration even in the absence of acute optic neuropathy. The important correlation between functional and anatomic aspect confirms the value of OCT to appreciate the subclinical involvement of the optic nerve. Associated with tests exploring visual function, the OCT could reveal itself pertinent in evaluation of the different therapeutics used in MS ON.