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This paper discusses benefits, caveats, and lessons learned of wireless pressure monitoring systems in abandoned exploration and appraisal wells to gain insight into reservoir properties that extend beyond the scope of standard well testing. Appraising large offshore deepwater discoveries requires drilling and evaluating several wells across a field to increase subsurface understanding and reduce development uncertainties. The recent technological advancement of wireless pressure monitoring systems, which utilize electromagnetic telemetry, has enabled operators to capitalize on previously untapped value from exploration and appraisal wells by turning them into long-term observation wells, without compromising abandonment compliance. Even if not tested, these penetrations can provide valuable dynamic data for enhanced reservoir characterization early in the appraisal life cycle and at little incremental cost. Such a system was installed in a deepwater well in Cyprus to further understand potential compartmentalization risks. A nearby well test, executed 3 years after system installation, was successfully monitored by the abandoned penetration. The interference test helped shed light on far-field connectivity, inter-well reservoir properties, and connected volume. This information will improve the fidelity of the geological and reservoir simulation models utilized to inform depletion planning and support field development and commercial decisions. This paper presents novel findings to help ensure data quality and representativeness from such systems, focusing on the overprint of the wellbore environment on the reservoir signal. Specifically, the deployment in a cased wellbore left with drilling fluid revealed lengthier and more complex swap-out dynamics with reservoir fluid than anticipated. As with most new technologies, subsequent installations benefited from these valuable lessons learned, resulting in more robust and reliable implementation practices.

PURPOSE: To characterize the features of choroidal neovascularization (CNV) secondary to angioid streaks (AS) with optical coherence tomography angiography (OCT-A) and to assess its sensitivity in CNV detection in this particular context. METHODS: Consecutive patients, both with treatment-naïve and recurrent CNV associated with angioid streaks were prospectively analyzed. All patients underwent macular imaging by fluorescein angiography (FA), indocyanine green angiography (ICGA), spectral-domain (SD)-OCT, and OCT-A (AngioVue, Optovue, Optovue Inc., Freemont, CA, USA). OCT-A detection rate of CNV associated to AS was evaluated by two independent observers. We studied the association between OCT-A feature and either exudative or active status using Fisher exact test. RESULTS: A total of 32 eyes of 18 consecutive patients were included in the analysis. OCT-A was able to detect CNV associated with angioid streaks in 87.5 % (28/32) eyes. OCT-A phenotypes of CNV were classified into interlacing pattern in 9 eyes, pruned vascular tree pattern in 7 eyes, and combined pattern in 12 eyes (Interuser agreement: 0.871 ± 0.071). CNV were not detectable in 4/32 eyes. There was a statistically significant association between the presence in OCT-A of densely ramified networks with both previous treatment status in the last 6 months (p

Background/purpose Neovascular age-related macular degeneration (nAMD) is frequently associated with vascularized pigment epithelial detachment (v-PED). We observed a peculiar characteristic of v-PED characterized by small lacy folds of the retinal pigment epithelium, appearing as a wrinkled PED (w-PED) on spectral domain optical coherence tomography (SD-OCT). Our purpose was to describe the visual prognosis and number of intravitreal injections in w-PED compared with non-w-PED. Methods In this retrospective, case-control series, we reviewed retrospectively medical records of 52 eyes of 51 patients who were consecutively included between November 1 and 30, 2015 with a previous minimum 3-year follow-up. Inclusion criteria were: neovascular age-related macular degeneration, affected with w-PED. Baseline characteristics, best-corrected visual acuity (BVCA), number of intravitreal anti-vascular endothelial growth factor injections (anti-VEGF IVT) and maximal recurrence-free interval, that is, without intravitreal anti-vascular endothelial growth factor injection, were analyzed. A w-PED was defined as a v-PED ≥200 μm in height on SD-OCT imaging, presenting with at least 4 small lacy folds on the surface of the retinal pigment epithelium. Patients were compared with a control group, that is, patients harboring PED without wrinkle shape (non-w-PED). All patients had been treated by intravitreal anti-vascular endothelial growth factor injection of either ranibizumab (IVR) or aflibercept (IVA) using a pro re nata (PRN) protocol after three initial monthly treatments, with a minimum of follow-up of 3 years. Results Two groups of patients were compared, w-PED (29 eyes, from 29 patients), and non-w-PED (23 eyes from 22 patients). In the w-PED group, mean BCVA evolved from 0.28 (±0.18) log MAR (20/40, range 20/25-20/63) at baseline, to 0.29 (±0.21) log MAR (20/40, range 20/25-20/63) at 1 year (P = 0.41), 0.34 (±0.26) log MAR (20/40, range 20/25-20/80) at 2 years (P = 0.49), 0.35 (±0.28) log MAR (20/40, range 20/25-20/80) at 3 years (P = 0.54). In the non-w-PED group, mean BCVA was 0.40 (±0.28) log MAR (20/50, range 20/25-20/100) at baseline and decreased to 0.48 (±0.46) log MAR (20/63, range 20/20-20/160) at 1 year (P = 0.19), 0.48 (±0.35) log MAR (20/63, range 20/25-20/125) at 2 years (P = 0.02), 0.60 (±0.38) log MAR (20/80, range 20/32-20/200) at 3 years (P = 0.002). In the w-PED group, the mean maximal documented recurrence-free interval was 7.87 (±2.94) months at Year 1, 13.5 (±7.52) at Year 2 and 14.78 (±10.70) at Year 3, versus 4.59 (±2.95) months at Year 1, 7.83 (±6.62) at Year 2, 8.57 (±11.18) at Year 3 in the non-w-PED group (P = 0.0004; 0.0101; 0.0168 respectively at Years 1, 2 and 3). Discussion The evolution of v-PED after intravitreal anti-vascular endothelial growth factor injection is still difficult to predict despite intense clinical research in this topic. In our study, we noticed that w-PED might be a phenotypic prognosis factor for better visual acuity and longer maximal recurrence-free interval.

Pseudoxanthoma elasticum (PXE), a rare hereditary connective tissue disorder, may be complicated by angioid streaks (AS) and choroidal neovascularization (CNV), which may lead to irreversible loss of visual acuity (VA). Here we describe the safety and efficacy of ranibizumab in patients with CNV secondary to PXE.A multicenter (n=23), observational study of a retrospective/prospective cohort, performed under real world conditions in France in all patients with CNV secondary to PXE who received at least one ranibizumab injection as of October 2011. The study objectives were to describe the mean annual number and reason for ranibizumab injections since initiation, evolution of best-corrected visual acuity (BCVA by Early Treatment Diabetic Retinopathy Study [ETDRS] letters), and safety.Patients (n=72; 98 eyes) had a mean age of 59.6±8.3years and consisted of 54.2% men. The criterion for retreatment was based mainly on loss of VA, progression of CNV and angiographic leakage. CNV was primarily subfoveal or juxtafoveal (73.4%), and the initial mean VA was 64.6 ETDRS letters. On average, visual acuity of all eyes analyzed was relatively stable during the 2-year follow-up (62.3 letters vs 64.6 letters at the first injection), and 88.6% of eyes maintained VA between -15 and +15 letters or gained over 15 letters. No deaths or new intolerances were described.These results showed that ranibizumab was able to maintain stable VA in clinical practice for at least 2years in patients with CNV secondary to PXE, and to significantly reduce the frequency of neovascularization relapses, with a limited number of injections. The treatment was well tolerated by the patients.

We have developed an inversion method to reduce shoulder-bed effects on pulsed neutron capture (PNC) logs for estimating layer-by-layer-capture cross sections Σ. The method is based on a previously developed rapid approximation of PNC logs. Tests performed on synthetic examples that include a variety of lithology, saturating-fluid, and bed-thickness configurations confirm the efficiency, reliability, and stability of the inversion procedure. Inversion consistently improves the vertical resolution and Σ definition of PNC logs across beds thinner than 45 cm. Our fast, iterative algorithm inverts Σ logs in seconds of CPU time and is therefore suitable for joint petrophysical interpretation with other open- and cased-hole logs.

Pulsed neutron capture (PNC) logs are commonly used for formation evaluation behind casing and to assess time-lapse variations of hydrocarbon pore volume. Because conventional interpretation methods for Σ logs assume homogeneous formations, errors may arise, especially in thinly bedded formations, when appraising petrophysical properties of hydrocarbon-bearing beds. There exist no quantitative interpretation methods to account for shoulder-bed effects on Σ logs acquired in sand-shale laminated reservoirs. Because of diffusion effects between dissimilar beds, Σ logs acquired in such formations do not obey mixing laws between the Σ responses of pure-sand and pure-shale end members of the sedimentary sequence. We have developed a new numerical method to simulate PNC rapidly and accurately logs. The method makes use of late-time, thermal-neutron flux sensitivity functions (FSFs) to describe the contribution of multilayer formations toward the measured capture cross section. It includes a correction procedure based on 1D neutron diffusion theory that adapts the transport-equation-derived, base-case FSF of a homogeneous formation to simulate the response of vertically heterogeneous formations. Benchmarking exercises indicate that our simulation method yields average differences smaller than two capture units within seconds of computer central processing unit time with respect to PNC logs simulated with rigorous Monte Carlo methods for a wide range of geometrical, petrophysical, and fluid properties.

Introduction Le fundus flavimaculatus (FFM) est une entite du syndrome de Stargardt. Elle atteint generalement des sujets jeunes et entraine, a plus ou moins long terme, une baisse d′acuite visuelle due a des zones d′atrophie ou par des flecks mal situes. Toutefois, des formes tardives ont ete decrites comme forme frontiere avec la degenerescence maculaire lie a l′âge (DMLA). En revanche, les complications a type de neovascularisation choroidienne sont rares. Observation Nous rapportons le cas d′un FFM de decouverte tardive chez une patiente de plus de 50 ans. Au cours de son suivi clinique, elle presenta une baisse d′acuite visuelle consecutive a une neovascularisation choroidienne juxtafoveolaire qui malgre le laser recidiva en position retrofoveolaire, obligeant en la realisation d′un laser perifoveolaire. Discussion En raison de nombreuses similitudes cliniques, la differenciation d′une DMLA et d′un Syndrome Stargard de debut tardif peut etre difficile. L′âge de la patiente etait en effet compatible avec celui d′une DMLA, et les signes precurseurs comme les drusen peuvent se confondre avec les flecks du FFM. La complication neovasculaire renforce cette similitude d′autant plus que les rares cas decrits dans la litterature touchent des sujets de plus de 50 ans. Les alterations de l′epithelium pigmentaire, liees a l′accumulation de dechets lipoproteique, pourraient predisposer a des ruptures de la membrane de Bruch et donc a une neovascularisation. Cette physiopathologie ressemble, la aussi, a celle de la DMLA. Conclusion Le Syndrome Stargardt de debut tardif peut donc se compliquer comme la DMLA d′une neovascularisation choroidienne. La frontiere entre ces deux pathologies semble donc encore s′attenuer.

PURPOSE: To compare the visual outcome of two different surgical approaches for subfoveal neovascularization in degenerative myopia: macular translocation and surgical removal of choroidal neovascularization (CNV). DESIGN: Interventional case series. METHODS: Retrospectively, 32 eyes with degenerative myopia (axial length over 26 mm or refraction over −6 diopters) and subfoveal CNV of 32 consecutive patients operated on by either surgical removal of CNV or limited macular translocation were reviewed. Surgical removal of CNV was performed in 18 eyes and limited macular translocation with a twofold suture in 14 eyes. The main outcome measurements were best-corrected visual acuity (BCVA) and findings from fluorescein angiography. Postoperatively, mean ± SD follow up was 14 ± 15 months (range, 6–48 months) in the removal group and 11 ± 4 months (range, 6–24 months, P = .37) in the translocation group. RESULTS: In both groups, there was no significant difference in preoperative age, sex, refractive error, or BCVA. The average of postoperative BCVA was statistically better after macular translocation (10 ETDRS lines or 20/100) than after surgical removal (6 lines 10/125, P = .019). Visual acuity improved by 3.8 lines after macular translocation and was unchanged after surgical removal (−0.7 line, P = .011). Macular translocation was successful in shifting the CNV to an extrafoveal location in 11 out of 14 eyes. Mean foveal displacement of all 18 translocated eyes was 695 ± 426 μm (range, 100–1520 μm). Recurrence of CNV occurred in seven eyes (39%) after surgical removal and in two eyes (14%) after translocation. Retinal detachment occurred in two eyes in each group. CONCLUSION: In this retrospective study, eyes with degenerative myopia and subfoveal neovascularization treated with limited macular translocation had better visual acuity recovery than eyes treated with surgical removal of the choroidal neovascularization. Further studies are required to confirm these results.

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.

Segmentation of bright blobs in an image is an important problem in computer vision and particularly in biomedical imaging. In retinal angiography, segmentation of drusen, a yellowish deposit located on the retina, is a serious challenge in proper diagnosis and prevention of further complications. Drusen extraction using classic segmentation methods does not lead to good results. We present a new segmentation method based on new transformations we introduced in mathematical morphology. It is based on the search for a new class of regional maxima components of the image. These maxima correspond to the regions inside the drusen. We present experimental results for drusen extraction using images containing examples having different types and shapes of drusen. We also apply our segmentation technique to two important cases of dynamic sequences of drusen images. The first case is for tracking the average gray level of a particular drusen in a sequence of angiographic images during a fluorescein exam. The second case is for registration and matching of two angiographic images from widely spaced exams in order to characterize the evolution of drusen.

International audience; Objective: To evaluate the relative efficacy and safety profile of bevacizumab versus ranibizumab intravitreal injections for the treatment of neovascular age-related macular degeneration (AMD). Design: Multicenter, prospective, noninferiority, double-masked, randomized clinical trial performed in 38 French ophthalmology centers. The noninferiority limit was 5 letters. Participants: Patients aged >= 50 years were eligible if they presented with subfoveal neovascular AMD, with best-corrected visual acuity (BVCA) in the study eye of between 20/32 and 20/320 measured on the Early Treatment of Diabetic Retinopathy Study chart and a lesion area of less than 12 optic disc areas (DA). Methods: Patients were randomly assigned to intravitreal administration of bevacizumab (1.25 mg) or ranibizumab (0.50 mg). Hospital pharmacies were responsible for preparing, blinding, and dispensing treatments. Patients were followed for 1 year, with a loading dose of 3 monthly intravitreal injections, followed by an asneeded regimen (1 injection in case of active disease) for the remaining 9 months with monthly follow-up. Main Outcome Measures: Mean change in visual acuity at 1 year. Results: Between June 2009 and November 2011, 501 patients were randomized. In the per protocol analysis, bevacizumab was noninferior to ranibizumab (bevacizumab minus ranibizumab +1.89 letters; 95% confidence interval [CI], -1.16 to +4.93, P< 0.0001). The intention-to-treat analysis was concordant. The mean number of injections was 6.8 in the bevacizumab group and 6.5 in the ranibizumab group (P=0.39). Both drugs reduced the central subfield macular thickness, with a mean decrease of 95 mm for bevacizumab and 107 mm for ranibizumab (P=0.27). There were no significant differences in the presence of subretinal or intraretinal fluid at final evaluation, dye leakage on angiogram, or change in choroidal neovascular area. The proportion of patients with serious adverse events was 12.6% in the bevacizumab group and 12.1% in the ranibizumab group (P=0.88). The proportion of patients with serious systemic or ocular adverse events was similar in both groups. Conclusions: Bevacizumab was noninferior to ranibizumab for visual acuity at 1 year with similar safety profiles. Ranibizumab tended to have a better anatomic outcome. The results are similar to those of previous head-to-head studies. (C) 2013 by the American Academy of Ophthalmology.

Purpose To analyze retrospectively the efficacy of intravitreal ranibizumab injections for the management of choroidal neovascularization (CNV) in patients with angioid streaks. Design Nonrandomized, double-center, retrospective, interventional case series. Methods A consecutive series of patients affected with CNV associated with angioid streaks were treated with intravitreal ranibizumab injections (0.5 mg/0.05 mL). Best-corrected visual acuity, fundus photography results, optical coherence tomography (OCT) results, and fluorescein angiography results were examined before and after treatment. The primary end point was the percentage of eyes with stable or improved visual acuity at the end of follow-up. Secondary end points were the percentage of eyes with stable or decreased macular thickness on optical coherence tomography and the percentage of eyes with persistent leakage on fluorescein angiography at the last follow-up examination. Results Thirty-five eyes of 27 patients were treated with repeated intravitreal ranibizumab injections (mean, 5.7 injections; range, 2 to 14 injections) for a mean of 24.1 months (range, 6 to 37 months). At the end of follow-up, visual acuity was stabilized or improved in 30 (85.7%) of 35 eyes. Macular thickness had stabilized or decreased in 18 (51.5%) of 35 eyes. At the last follow-up examination, on fluorescein angiography, no further leakage was observed in 23 (65.7%) of 35 eyes. Conclusions In this large series of angioid streaks-associated CNV, ranibizumab injections allowed stabilization of visual acuity. Ranibizumab seems to be a safe therapeutic option in CNV associated with angioid streaks.

To assess effectiveness, cost, and cost-effectiveness of ranibizumab versus the current medical practices of treating age-related macular degeneration in France.A simulation decision framework over 1 year compared ranibizumab versus the usual care using two effectiveness criteria: the "visual acuity improvement rate" (greater than 15 letters on the ETDRS scale) and the "rate of legal blindness avoided". Two decision trees included various sequences of current treatments, with or without ranibizumab.Ranibizumab appeared significantly more effective than the usual care (p0.001), providing greater treatment success rate of visual acuity improvement (48.8% versus 33.9%). The cost of the ranibizumab strategy was higher (9,123 euros over 1 year for ranibizumab versus 7,604 euros for the usual care) but the average cost-effectiveness was lower--18,721 euros/success for ranibizumab versus 22,543 euros/success for usual care (p0.001). Considering the "legal blindness avoided" success criterion, the ranibizumab strategy appeared significantly more effective (p0.001), providing greater treatment success rate for of legal blindness avoided than usual care (99.7% versus 93.1%) although it was more expensive (9,196 euros over 1 year for ranibizumab versus 5,713 euros for the usual care).Ranibizumab significantly improved the rate of visual acuity improvement and reduced the rate of legal blindness. Ranibizumab appeared significantly more cost-effective than the usual treatments in terms of visual acuity improvement.

Persistent macular edema (ME) is the main cause of poor visual outcome in nonischemic retinal vein occlusion (RVO). The aim of this study was to evaluate the results of surgery in this disorder.Retrospective nonrandomized comparative pilot study. Visual acuity measurement, fluorescein angiography, and optical coherence tomography were performed before and after treatment, at 3 months, 6 months, and 1 year.The study included 42 eyes: 15 eyes underwent vitrectomy with peeling of the posterior hyaloid and/or the internal limiting membrane, 19 received intravitreous injection of triamcinolone (IVT), and four had a combination of both treatments. In the vitrectomy group, 63% of the eyes showed a progressive decrease of ME throughout the year of follow-up (p0.05 at 1 month and 1 year) and an increase in visual acuity (p0.05 at 3 and 6 months); no complication occurred. In the IVT group, the eyes showed a rapid improvement in vision and in ME at 1 month (p=0.007 and p=0.001, respectively) but with a frequent ME recurrence at 4 months; however, 31% of eyes showed durable improvement. Complications after IVT were pseudo-endophthalmitis (one eye), transient hypertony (53%), and a full-thickness macular hole (one eye). In the group treated with vitrectomy combined with IVT, ME decreased rapidly and durably, but vision did not improve in this small subgroup of long-lasting RVO with prior pigment epithelial changes.In some eyes, vitrectomy seems to have a more durable effect than IVT alone. Further randomized and controlled studies are needed to confirm these results and to compare them to the natural course of the disease.

Fundus flavimaculatus is an aspect of Stargardt disease, which is characterized by juvenile onset, rapidly progressive deterioration, and poor visual outcome due to atrophic areas or flecks. Recently, a late-onset form has been described, on the borderline with AMD. However, choroidal neovascular complications are not frequent and rarely described in Stargardt's disease.Late discovery of FFM in a patient over 50 years old. During her follow-up, she presented a decrease in visual acuity due to juxtafoveal choroidal neovascularization. In spite of laser treatment, a retrofoveal recurrence appeared, which was treated with perifoveal laser.Confusion between AMD and a late-onset Stargardt may occur because of their many clinical similarities. The population and the fundus results can be similar to AMD and an examiner may be confused. In the literature, choroidal neovascular complications appear in patients over 50 years of age who may suffer from AMD. In fundus flavimaculatus, pigmentary epithelium alterations are due to progressive lipoproteic scrap storage that predisposes to Bruch's membrane rupture and choroidal neovascularization. This physiopathology resembles the that of AMD.Choroidal neovascular complications are possible in late-onset Stargardt disease. Their appearance together may be greater than previously believed.

The goal of this article is the segmentation of angiographic eye fundus images in order to extract "drusen", yellowish deposits at the retina level. Since classical segmentation methods are not efficient for the automatic extraction of drusen, we introduce a new adaptive approach. We give an adaptive algorithm based on mathematical morphology transforms. For the "maxima h-/spl infin/" transform, we propose an automatic definition of the contrast parameter h. We also introduce an approach with a non-constant function, h(x). The result highlights the bright blobs over an uniform background. Our method gives very satisfying results on typical images.

This paper deals with a new algorithm for automatic edge detection of retinal structures on angiographic frames. Usually, the determination of these structures and their accurate locations are based on a manual mapping wich is time consuming, tedious and not error-free. Computer image processing allows to automate the mapping and increases the reliability of extracted parameters. Therefore, we realize a process to automatically detect retinal structures. This process is based on the photometric and geometric properties of these structures. The results shown that the automatic mapping is more accurate and more reliable than manual mapping.

Macular drusen, hard or soft, have been often observed at the early stages of age-related macular degeneration. Clinically, it has been shown that soft drusen and macular subretinal new vessels are associated in a statistically significative manner. The question is to recognize and to determine drusen at greatest risk for developing choroidal neovascularization? To answer to this question, a method of digital images analysis of fluorescein angiography had been perfected. About ten eyes, preliminary results show, an objective and quantitative difference of the evolution of the grey level during the same angiogram between the different retinal structures. This method would bring a prognostic feature for the long term follow-up of patients with drusen.

Introduction Les etudes prospectives randomisees de phase III MARINA et ANCHOR ont demontre la superiorite du traitement par injections intravitreennes de Ranibizumab dans les lesions neovasculaires de la DMLA de localisation retrofoveale par rapport a la therapie photodynamique (PDT) a la Verteporfine. Tous les patients inclus dans ces etudes etaient des patients presentant des lesions « fraiches », n’ayant pas recu de traitement auparavant. Le degre d’efficacite du traitement sur des patients prealablement traites par l’association PDT a la Verteporfine et injections intravitreennes de Triamcinolone (TA), n’a pas ete specifiquement evalue. Materiels et Methodes 15 patients consecutifs traites sans succes (perte de plus de 3 lignes d’acuite visuelle, ou complications post-traitement immediat) par PDT a la Verteporfine et injections intravitreennes de TA, ont ete traites par injections intravitreennes repetees de Ranibizumab. Les patients ont ete initialement evalues par angiographie fluoresceinique, angiographie au vert d’indocyanine et tomographie en coherence optique (OCT), puis suivi par OCT sur une base mensuelle et par angiographie sur une base trimestrielle. Resultats L’acuite visuelle est restee stable (+/- 3 lignes ETDRS) apres 6 mois d’evolution chez la majorite des patients. L’evolution anatomique s’est faite vers la regression des signes exsudatifs, soit vers la fibrose soit vers une regression partielle des neovaisseaux. Discussion Le « passage » a un traitement de Ranibizumab semble donc benefique a court terme sur le plan de la fonction visuelle, meme pour des lesions evoluant deja depuis plusieurs mois et n’ayant pas prealablement repondu favorablement a un traitement par PDT a la Verteporfine associe a des injections intravitreennes de TA. Conclusion Le traitement par injections intravitreennes de Ranibizumab de patients prealablement traites sans succes par PDT et injections intravitreennes de TA, a permis de stabiliser l’acuite visuelle dans la majorite de cas a moyen terme.

Introduction Des etudes prospectives randomisees ont demontre la superiorite du traitement par injections intravitreennes (IVT) de Ranibizumab dans les lesions neovasculaires de la DMLA par rapport a la phototherapie dynamique (PDT) a la Verteporfine. Les patients inclus dans ces etudes presentaient des lesions recentes, n’ayant pas recu de traitement auparavant. L’efficacite du Ranibizumab chez les patients prealablement traites par PDT n’a pas ete specifiquement evaluee, et sera le but de cette etude retrospective. Objectifs et Methodes 22 patients consecutifs traites sans succes (perte de plus de 3 lignes d’acuite visuelle, ou complications post-traitement immediat) par PDT (moyenne : 2,7 PDT ; min 1, max 7) ont ete traites par IVT repetees de Ranibizumab. Les patients ont ete initialement evalues par angiographie fluoresceinique, angiographie au vert d’indocyanine et tomographie en coherence optique (OCT), puis suivis par OCT tous les mois et par angiographie a la fluoresceine a 3 et 6 mois. Resultats L’acuite visuelle moyenne enregistree avant les IVT de Ranibizumab (0,2/10) est restee stable apres 6 mois d’evolution (AV moyenne a 6 mois 0,16). Chez tous les patients nous avons enregistre une nette reduction des phenomenes exsudatifs en OCT et de la diffusion angiographique avec une tendance a la cicatrisation neovasculaire, parfois accompagnee par une fibrose sous retinienne. Discussion Le traitement par IVT de Ranibizumab de patients prealablement traites sans succes par PDT a permis de stabiliser l’acuite visuelle dans la majorite de cas a moyen terme. Conclusion Les IVT de Ranibizumab semblent avoir des resultats fonctionnels et anatomiques positifs, meme pour des lesions evoluant deja depuis plusieurs mois et n’ayant pas prealablement repondu favorablement a un traitement par PDT.

Introduction L’etude randomisee prospective de phase III MARINA a demontre l’efficacite du traitement par injections intravitreennes de Ranibizumab dans les lesions neovasculaires de la degenerescence maculaire liee a l’âge de type occultes pures et a composante classique minoritaire. Les decollements fibrovasculaires de l’epithelium pigmentaire n’ont toutefois pas fait l’objet d’une evaluation specifique, alors meme qu’il s’agit d’un sous-groupe au pronostic reserve. Materiels et Methodes 15 patients consecutifs diagnostiques comme atteints d’un decollement fibrovasculaire de l’epithelium pigmentaire retrofoveal, ont ete traites dans le cadre des autorisations compassionnelles par injections intravitreennes repetees de Ranibizumab. Les patients ont ete initialement evalues par angiographie fluoresceinique, angiographie au vert d’indocyanine et tomographie en coherence optique, puis suivi par tomographie en coherence optique sur une base mensuelle et par angiographie sur une base trimestrielle. Resultats L’acuite visuelle est restee stable (+/− 3 lignes ETDRS) apres 6 mois d’evolutions chez la majorite des patients Une amelioration de l’acuite visuelle d’au moins une ligne a ete observee chez 30 % et une diminution (inferieure a 3 lignes dans tous les cas) chez 60 % des patients. Discussion Le traitement par injections intravitreennes de Ranibizumab des decollements fibrovasculaires de l’epithelium pigmentaire dans la degenerescence maculaire liee a l’âge permet une stabilisation de l’acuite visuelle dans la grande majorite des patients. Conclusion Le traitement des decollements fibrovasculaires de l’epithelium pigmentaire par injections intravitreennes de Ranibizumab semble une option therapeutique plus prometteuse que le traitement par therapie photodynamique a la Verteporfine ou le traitement par injections intravitreennes de Pegaptanib.

Intravitreous injection: retrospective study on 2028 injections and their side effects M. C. Angulo Bocco, A. Glacet-Bernard, A. Zourdani, G. Coscas, G. Soubrane Objective: To observe the tolerance of repeated intravitreous injections over the short and long term and to analyze their complications. Patients and methods: The clinical records of consecutive patients having one or several intravitreous injections between 2002 and 2007 were evaluated, for all indications except the treatment of endophthalmitis. Results: 2028 intravitreous injections were performed, mainly for age-related macular degeneration (n=1 192) or macular edema secondary to diabetes mellitus or retinal vein occlusion (n=41). The injected drug was triamcinolone acetonide 4 mg (339 injections), pegaptanib sodium 0.3 mg (1179 injections), and ranibizumab 0.3 (497 injections). The patients received 1-27 intravitreous injections per eye. The main complications were endophthalmitis (two after triamcinolone, 0.1% of the total group), pseudoendophthalmitis (two after triamcinolone, 0.1% of the total group), hypertony (7.69% of the total group, 13.78% after triamcinolone, 3.56% after pegaptanib, 1.21% after ranibizumab), including five cases of acute hypertony with transient light perception loss after ranibizumab, cataract (0.44% of total group), and macular hole (one patient after triamcinolone). No case of retinal detachment nor systemic complication was observed. Discussion: Most of the complications were observed with the use of nonfiltered triamcinolone. The incidence of endophtalmitis was considerably lower with increased experience and the use of a dedicated room for the injections. Repeated injections were locally well tolerated. Conclusion: With the strict respect of asepsis rules, intravitreous injection seems well tolerated over the short and long term.

Introduction Les neovaisseaux choroidiens retrofoveaux compliquant les stries angioides restent de pronostic severe, meme traites par therapie photodynamique. L’efficacite du traitement par injections intravitreennes (IVT) de Pegaptanib a ete demontree par une etude prospective randomisee pour les neovaisseaux choroidiens retrofoveolaires compliquant la DMLA. Ce traitement a donc ete essaye pour des neovaisseaux choroidiens retrofoveolaires compliquant des stries angioides. Materiels et Methodes 6 patients consecutifs traites sans succes (perte de plus de 3 lignes d’acuite visuelle) par therapie photodynamique a la Verteporfine, ont ete traites par IVT repetees de Pegaptanib. Les patients ont ete initialement evalues par angiographie fluoresceinique, angiographie au vert d’indocyanine et tomographie en coherence optique (OCT), puis suivi par OCT sur une base mensuelle et par angiographie toutes les six semaines. Resultats L’acuite visuelle est restee stable (+/- 3 lignes ETDRS) apres 6 mois d’evolution chez 4 patients et s’est aggravee chez 2 patients. L’evolution anatomique favorable s’est faite soit vers la fibrose soit vers une regression partielle des neovaisseaux. Discussion Le traitement par injections intravitreennes de Pegaptanib de patients prealablement traites sans succes par PDT a la Verteporfine a permis de stabiliser l’acuite visuelle dans 66 % des cas a moyen terme. Conclusion Le traitement par Pegaptanib semble donc benefique a court terme sur le plan de la fonction visuelle pour les neovaisseaux choroidiens compliquant des stries angioides, meme pour des lesions n’ayant pas prealablement repondu favorablement a un traitement par PDT a la Verteporfine.

Objectif Evaluer l’efficacite, le cout et le ratio cout/efficacite du Ranibizumab par rapport a la strategie therapeutique actuelle dans la Degenerescence Maculaire Liee a l’Âge (DMLA) en France. Materiels et Methodes Deux arbres evenementiels ont ete formalises sur un horizon temporel d’un an. Le taux de cecites legales evitees a ete choisi comme critere d’efficacite. Le premier arbre evenementiel represente la strategie habituelle selon les traitements et procedures actuellement disponibles. Le second arbre evenementiel integre le Ranibizumab dans la strategie therapeutique. Un traitement est modifie apres 3 mois en cas d’echec alors qu’un meme traitement est maintenu tant qu’il est efficace. Une analyse de sensibilite de type probabiliste a ete conduite par les techniques de Monte-Carlo. Les lois de distribution ont ete specifiees pour chaque parametre cout et chaque probabilite de transition. Resultats La strategie incluant le Ranibizumab est significativement plus efficace (p Discussion Ce type de modelisation par simulation des distributions des couts et des criteres d’efficacite est tout a fait adapte a la DMLA car il prend en compte la variabilite de tous les parametres ainsi que des pratiques. Conclusion Cette etude originale etablit une reduction significative du taux de cecite legale a un an grâce au Ranibizumab. Les differences de couts et de ratios couts/efficacite apparaissent limitees et acceptables en regard de la valeur ajoutee clinique et sociale du Ranibizumab en termes de cecites legales evitees.

Fifteen cases of jaw-winking blepharoptosis treated, are reported, to suggest the management of the surgical methods. The degree of the ptosis, the eyelid retraction, the surgical procedures are reviewed. Patients with a wild retraction required a levator muscle resection. Patients with a moderate or severe retraction required an unilateral levator denervation with frontalis suspension. In this case, the most satisfactory surgical results were obtained with unilateral levator denervation on the affected side compared with a bilateral frontalis suspension with fresh autogenous fascia. Then, the surgical procedure seems to depend especially on the eyelid retraction.

Eighty patients admitted to hospital between 1975 and 1980 for "non-transmural" myocardial infarction (72 men, 8 women, mean age 56 +/- 9 years) were studied. The diagnosis was based on a severe attack of pain of over 30 minutes duration, increased serum cardiac enzyme levels (CKMB greater than 24 U; SGOT greater than 60 U), pyrexia and signs of inflammation. The patients were divided into two groups according to their ECG changes: Group A: "rudimentary" infarction with prolonged T wave inversion from V1 to V5, narrow transient Q waves and reduction of R wave amplitude in the corresponding leads; Group B: persistant prolonged, intercritical ST depression greater than 2.5 mm (subendocardial infarct). All patients underwent selective coronary angiography and left ventriculography in the RAO projection within 15 days of admission. The angiographic data (coronary score, ejection fraction, alinetic perimeter) were compared to those of 2 randomly chosen control groups: Group C: 30 inferior wall infarcts with coronary angiography and regularly followed-up; Group D: 30 transmural anterior infarcts with coronary angiography, regularly followed-up. Four factors were analysed during follow-up: the incidence of death after discharge from hospital, transmural infarction, unstable angina and cardiac failure. All patients were treated medically (nitrate derivatives, betablockers, calcium antagonists). Sixteen patients in Group A (p less than 0,025) were operated and excluded from the prognostic study. The angiographic data showed a high incidence of isolated, severe LAD disease in Group A (59.2% of cases) and that multivessel disease was commoner in Group B (78.4%). A collateral circulation revascularising the LAD was observed in 42% of patients in Group A. (ABSTRACT TRUNCATED AT 250 WORDS)

Myocardial infarction under the age of 35 is no longer a rarity. A series of 22 patients exhibited all the usual epidemiological, clinical and angiographic features of the disease: risk factors, predominantly excessive smoking associated with dyslipoproteinaemia in 50% of the cases; onset during exercise in one quarter of the cases, more frequently than in elderly people; and absence of significant lesions at angiography in one third of the cases. Angiography of the coronary arteries, performed in the early stages of infarction in 5 patients, demonstrated the presence of several factors in the pathogenesis of arterial occlusion in young people, i.e. thrombosis in almost every case, arterial spasm in 10% of the patients and atheromatous plaques with little or no stenosis in one half.