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Purpose: To evaluate the initial experience of four experienced vitreoretinal surgeons, in France, with a three-dimensional (3-D) system, and to explore the potential advantages and disadvantages o...

Purpose The incidence and severity of diabetes is particularly high in the French overseas territories (FOT). The RECIF study evaluated real life management of diabetic macular oedema (DME) treated by aflibercept in FOT. Methods A prospective, noncomparative, multicentric, non-interventional, study that evaluated functional and anatomical results of patients treated by aflibercept. Twelve retina specialists working in French Polynesia, La Reunion, Guadeloupe and Martinique participated in the study. Results 67 eyes of 57 patients were followed for 12 months. Average VA gain was 7.8 ETDRS letters. 29.9% of eyes gained at least 15 letters, 6% lost 15 letters or more. 67.2% of eyes achieved visual acuity of 70 letters or better. Average central retinal thickness decrease was 115.3 µm. The mean number of injections during the 1st year of treatment was 4.9. 69% of eyes had a loading dose of at least three-monthly injections. 3 eyes were switched to steroid injections during the follow-up for lack of efficacy. Conclusion This study confirmed the efficacy of intravitreal treatment of DME by aflibercept, in the French overseas territories. This evaluation of real-life management of DME underlines the importance of improvement of patient education and collaboration with referring physicians.

PURPOSE To determine the preoperative factors influencing visual recovery after vitrectomy for myopic foveoschisis. METHODS Sixty-six eyes of 65 consecutive patients operated on for myopic foveoschisis were retrospectively included. All eyes underwent a preoperative ocular examination including best-corrected visual acuity (BCVA) and spectral domain optical coherence tomography with central foveal thickness measurement and foveal status classification: simple foveoschisis, foveal detachment, or macular hole. To study the impact of preoperative visual acuity, 4 visual acuity groups separated by quartile ranges were defined. Postoperative visits at 1, 3, or 12 months including BCVA measurement and optical coherence tomography were recorded. RESULTS Mean refraction was -15.90 diopters, mean axial length was 30.30 mm, mean central foveal thickness was 590 μm, and mean baseline logarithm of the maximum angle of resolution visual acuity was 0.68 (Snellen equivalent of 20/96). The final BCVA improved significantly from 3 months after surgery until the last follow-up visit; the mean logarithm of the maximum angle of resolution visual acuity at last follow-up was 0.43 (Snellen equivalent of 20/54). Mean central foveal thickness decreased significantly as soon as the first postoperative month (P < 0.0001). The preoperative BCVA was the only independent factor significantly correlated with the final BCVA as opposed to the foveal status (P < 0.0001). The mean BCVA and mean visual gain at the last follow-up visit were significantly different between the four visual acuity groups (P < 0.0001 and P = 0.017, respectively). CONCLUSION The main factor influencing the postoperative visual acuity is the preoperative visual acuity. Although the preoperative anatomical status seemed important in surgeon decision making, once normalized on visual acuity, it no longer influenced the postoperative visual acuity.

Background To assess the impact of unstudied societal factors for neovascular age-related macular degeneration (nAMD) on functional outcomes after anti-VEGFs. Methods Charts of 94 nAMD patients treated in the Monticelli-Paradis Centre, Marseille, France, were reviewed. Phone interviews were conducted to assess societal factors, including transportation, living status, daily reading and social security scheme (SSS). Primary outcome was the impact of family support and disease burden on functional improvement in nAMD. Results Between baseline and month 24 (M24), 42.4% of the variability in best-corrected visual acuity (BCVA) was explained by the cumulative effect of the following societal factors: intermittent out-patient follow-up, marital status, daily reading, transportation type, commuting time. No isolated societal factor significantly correlated with ETDRS BCVA severity at M24. A trend to correlation was observed between the EDTRS score at M24 and the SSS (P = 0.076), economic burden (P = 0.075), time between diagnosis and treatment initiation (P = 0.070). A significant correlation was found for the disease burdensome on the patient (P = 0.034) and low vision rehabilitation (P = 0.014). Conclusions Societal factors could influence functional outcomes in nAMD patients treated with anti-VEGFs. They could contribute to the healing process or sustain disease progression. Electronic supplementary material The online version of this article (10.1186/s12886-018-0690-9) contains supplementary material, which is available to authorized users.

Background To report a case of complete progressive visual recovery and healing of outer retinal layers after vitrectomy for foveal detachment associated with optic disc pit. Case presentation Optical coherence tomography (OCT) follow-up was performed on a 15-year-old boy with deep optic disc pit and foveal detachment, before and for 10 years after vitrectomy with gas. The foveal detachment was successfully reattached with complete reapplication of the retina. OCT scans showed a progressive long-term retinal healing with reappearance of the ellipsoid line and visual acuity improved from 20/100 before surgery to 20/25, 10 years after surgery. Conclusions Photoreceptor regeneration after foveal detachment surgery has been already described only in zebrafish but never humans. However, we highlight with this case that in humans, a healing process of the outer retinal layers can occur with reappearance of the ellipsoid zone on OCT. This healing process may take several years and allow a complete functional restoration.

L’exode rural est derriere nous. Les campagnes connaissent de profondes mutations. La recomposition sociale qui s’y opere va plus vite que les representations que nous gardons de ce milieu. Les territoires ruraux accueillent un nombre croissant d’habitants d’âges varies. Les agriculteurs s’y font rares. Comme partout, la tertiairisation des activites gagne en importance. Recherchees, les campagnes d’aujourd’hui deviennent des espaces a forts enjeux. Reste a savoir si ces nouvelles ruralites, dans un contexte d’homogeneisation des pratiques sociales, existent encore vraiment comme territoire specifique.

Cette recherche constitue une meta analyse du phenomene d'auto-organisation d'un systeme complexe, dans un contexte de catastrophe naturelle et technologique. Le contexte de catastrophe naturelle et technologique induit un tres haut niveau de complexite pour la societe, pour le systeme d'intervention d'urgence ainsi que pour le citoyen. L'auto-organisation s'avere un phenomene qui a particulierement ete observe dans ce contexte (Denis, 2002). Le choix de la meta analyse s'explique par la double necessite de l'ouverture et de la « multidimensionnalite explicationnelle » pour traiter de la complexite, tel que propose dans l'ouvrage de synthese d'epistemologie de Vergnioux (2003). La complexite de la situation de catastrophe naturelle et technologique induit des problemes de gestion et d'integration entre les organisations mandatees et specialisees en intervention, de meme qu'avec les groupes auto-organises (Nicolet, 1999; Townsend, 2006). La recherche vise, notamment, a repondre aux questions formulees par la Commission Nicolet (1999) au sujet de l'auto-organisation, notamment : « Comment rester independant tout en pretant son concours et en participant aux activites des pouvoirs publics ? Comment conserver le caractere d'auto-organisation tout en reclamant une intervention de ces memes pouvoirs publics ? » Ce travail de recherche permet de rassembler et d'etudier, par le biais d'une revue litteraire approfondie, des analyses de syntheses theoriques provenant de differents champs d'etudes, permettant ainsi de conceptualiser de differente facon l'auto-organisation d'un systeme complexe. Des prolongations aux modeles de syntheses sont proposees, notamment pour le paradigme de vie de Morin (1980) et pour la metaphore du cerveau holographique de Morgan (1997). De surcroit, la recherche s'interroge sur l'impact de la complexification spontanee de l'environnement sur les organisations. Le travail de recherche rassemble un cadre theorique sur les modeles strategiques des organisations a partir de la theorie de la contingence structurelle, et retient tout particulierement la synthese de Miller (1996). Cherchant une perspective complementaire permettant une observation de l'ensemble vers de nouveaux ordres etablis, ce memoire explore la theorie des sous-ensembles (Combes, 2001 ; Durieux, 2001 ; Trivers, 1971) et la theorie des jeux liee a la recherche sur l'evolution de la cooperation (Doebeli et Hauert, 2005). Issus de cette exploration theorique, les principes et les strategies pouvant favoriser la cooperation entre des organisations sont egalement proposes. D'autre part, l'approche des systemes adaptatifs complexes est presentee. Celle-ci fournit des applications pratiques d'analyses theoriques ainsi que des modeles de syntheses a l'intention des gestionnaires et des agents de liaison. La conclusion du memoire laisse entrevoir des perspectives de recherche dont les contributions specifiques sont definies par le principe de causalite complexe de Morin(1980).