Search

Purpose: To evaluate the visual field rate of progression of patients with treated ocular hypertension (OHT) and primary open-angle glaucoma (POAG) in clinical practice, using the mean deviation (MD) and the visual field index (VFI)., Methods: Non-interventional cohort study. From a large multicentre database representative of the French population, 441 eyes of 228 patients with treated OHT or POAG followed up at least 6 years with Humphrey 24.2 Sita-Standard visual field examination at least twice a year were identified. From initial data, eyes were classified in five groups: 121 with OHT, 188 with early glaucoma (MD greater than -6 dB), 45 with moderate glaucoma (MD -6 to -12 dB), 41 with advanced glaucoma (MD -12 to -18 dB) and 46 with severe glaucoma (MD less than -18 dB). Rate of progression during the follow-up period was calculated using the trend analysis of the Guided Progression Analysis software., Results: The mean duration of follow-up was 8.4 ± 2.7 years and the mean number of visual field, 18.4 ± 3.5. In eyes with OHT, rate of progression was -0.09 dB/year (-0.17%VFI/year). In eyes with POAG, rate of progression was -0.32 dB/year (-0.83%VFI/year) in eyes with early glaucoma, -0.52 dB/year (-1.81%VFI/year) in moderate glaucoma, -0.54 dB/year (-2.35%VFI/year) in advanced glaucoma and -0.45 dB/year (-1.97%VFI/year) in severe glaucoma. In eyes with POAG, a significant progression (p < 0.05) was detected in 159 of 320 eyes (49.7%) with trend analysis and 117 of 320 eyes (36.6%, likely progression) or 183 of 320 eyes (57.2%, possible and likely progression) with event analysis., Conclusions: Primary open-angle glaucoma is a progressive disease in the majority of patients despite cautioned treatment and follow-up. The rate of progression varies greatly among subjects., (© 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

The exact pathophysiology of glaucoma is not fully understood. Understanding of the vascular pathophysiology of glaucoma requires: knowing the techniques for measuring ocular blood flow and characterizing the topography of vascular disease and the mechanisms involved in this neuropathy. A decreased mean ocular perfusion pressure and a loss of vascular autoregulation are implicated in glaucomatous disease. Early decrease in ocular blood flow has been identified in primary open-angle glaucoma and normal pressure glaucoma, contributing to the progression of optic neuropathy. The vascular damage associated with glaucoma is present in various vascular territories within the eye (from the ophthalmic artery to the retina) and is characterized by a decrease in basal blood flow associated with a dysfunction of vasoregulation., (Copyright © 2015. Published by Elsevier Masson SAS.)

Purpose: The objective of his study was to compare the visual and anatomical outcomes in treatment-naïve patients with macular edema secondary to retinal vein occlusion after intravitreal injections of dexamethasone implants (DEX) and anti-VEGF., Methods: One hundred two patients (64 in the anti-VEGF group, 38 in the DEX group) without previous treatment were included in this multi-center retrospective study and evaluated at baseline and 1, 3, 6, and 12 months after the onset of treatment. Patients were defined as "good responders" if central macular thickness (CMT) was less than or equal to 250 μm in TD-OCT or 300 μm in SD-OCT after the injections., Results: At month 3 (n = 102), BCVA had increased significantly, by 0.1 ± 0.3 logMAR in the anti-VEGF group (p = 0.04) and 0.4 ± 0.4 logMAR in the DEX group (p < 0.001); the difference between the two groups was statistically significant (p = 0.007). CMT decreased significantly, by 138 ± 201 μm (-19 %, p < 0.001) in the anti-VEGF group and 163 ± 243 μm (-21 %, p < 0.001) in the DEX group. After 3 months, five patients (13 %) in the DEX group and 20 (31 %) in the anti-VEGF group (p < 0.001) changed treatment. Among the 77 patients who did not switch from their initial treatment, no significant functional or anatomical difference between the two groups was observed at months 6 and 12. Elevation of intraocular pressure > 21 mmHg was more frequent in the DEX group (21 %) than in the anti-VEGF group (3 %, p = 0.008)., Conclusions: Visual acuity recovery was better in the DEX group than in the anti-VEGF group at month 3, but with no difference in CMT. In patients who did not change treatment, the long-term anatomical and visual outcome was similar between the DEX and anti-VEGF groups.

Purpose: The purpose of this study was to evaluate the hemorrhagic risk factors during the management of primary rhegmatogenous retinal detachment (RD)., Methods: Three hundred and twenty-two patients with (n = 74) or without (n = 248) bleeding (anterior segment, choroidal, intravitreal and/or subretinal) during or after RD surgery were included in this case-control study. Exclusion criteria were: history of trauma, vitreoretinal surgery, diabetic retinopathy, and taking clopidogrel and/or a vitamin K antagonist. Univariate and multivariate analyses were performed to identify risk factors of perioperative bleeding., Results: Aspirin was not significantly associated with bleeding complications during or after surgery (p = 0.8). Scleral buckling (with cryotherapy and gas tamponnade) was performed in 47 % of the cases and pars plana vitrectomy in 53 % of the cases. Independent risk factors of perioperative hemorrhage were the number of cryotherapy impacts (odds ratio =1.12 [1.06; 1.20], 95 % confidence interval), transscleral drainage (OR = 4.22 [1.62; 10.98]), and use of pars plana vitrectomy (OR = 3.39 [1.36; 8.47]). Bleeding complications were associated with a lower single-operation anatomical success rate (74 % vs 84 %, p = 0.03). There was also a trend toward an association between bleeding complications, a higher total number of RD recurrences (0.19 ± 0.5 in the non-bleeding group vs 0.34 ± 0.6, p = 0.06), and a lower final visual acuity (0.5 ± 0.6 logMAR vs 0.7 ± 0.7, p = 0.09)., Conclusion: This case-control study suggests that aspirin is not a major risk factor of hemorrhagic complications during and after RD surgery. Perioperative bleeding leads to a lower single-operation anatomic success rate.

Purpose: The purpose of this study was to characterize the relationships between nocturnal intraocular pressure (IOP) variations and sleep macrostructure in healthy subjects., Methods: This was a cross-sectional study conducted in a center with shared expertise in chronobiology. Twelve healthy volunteers (22.3 ± 2.3 years) underwent a 24-hour IOP measurement session. The IOP variations of one eye were continuously estimated using a contact lens sensor (CLS) measuring the changes in corneal curvature related to the IOP and not requiring nocturnal awakening for measurements. The CLS measurement characteristics (mean, maximum, minimum, and amplitude) were evaluated across sleep stages (non-rapid eye movement [NREM] sleep [N1, N2, N3], REM) and assessed using polysomnography. The CLS signal measurement changes during sleep stage changes were calculated to evaluate the effects of sleep on IOP., Results: A 24-hour IOP nyctohemeral rhythm was found in all subjects. During the nocturnal period, IOP signal values were significantly lower during wake stages than during REM and NREM N1, N2, and N3 sleep stages (P ≤ 0.04). The IOP signal values were significantly higher during the REM stage than during the NREM stages (P ≤ 0.03) and progressively decreased as NREM sleep deepened (P ≤ 0.04). We found a positive relationship between the micro-arousal index and the nocturnal period CLS signal SD (r = 0.76; P = 0.024) and a negative relationship between sleep efficiency and the nocturnal period CLS signal SD (r = -0.69; P = 0.041)., Conclusions: Sleep micro- and macrostructure and nocturnal IOP variations are closely related in young subjects without sleep disorders. Across sleep stages, IOP is highest during REM sleep and progressively decreases as NREM sleep deepens.

Importance: The prevalence of obstructive sleep apnea syndrome (OSAS) in patients with nonarteritic anterior ischemic optic neuropathy (NAION) and its influence on second eye involvement is not well known., Objective: To evaluate the prevalence of OSAS in patients with NAION and risk factors of second eye involvement., Design, Setting, and Participants: In this cohort study, we examined 118 patients with anterior ischemic optic neuropathy referred to a tertiary care center from January 1, 2003, through December 31, 2010., Exposures: Patients underwent polysomnography to detect OSAS and were prospectively followed up to assess the risk of second eye involvement., Main Outcomes and Measures: The prevalence of OSAS in patients with NAION and the risk of second eye involvement using survival analysis based on the presence of OSAS, indication for ventilation treatment with continuous positive airway pressure, and other potential ocular and systemic confounders., Results: In 89 patients with NAION who underwent polysomnography, 67 (75%) had OSAS. Second eye involvement was found in 10 (13.7%) of 73 patients at 3 years: 8 (15.4%) of 52 patients with OSAS at 3 years and 2 (9.5%) of 21 patients without OSAS at 3 years; P = .04. In multivariate analysis, nonadherence to ventilation treatment with continuous positive airway pressure in patients with severe OSAS increased the risk of second eye involvement (hazard ratio, 5.54; 95% CI, 1.13-27.11; P = .04)., Conclusions and Relevance: These results suggest that OSAS is common in patients with NAION and that polysomnography should be considered in these patients. These findings also suggest that patients with severe OSAS who are nonadherent to ventilation treatment with continuous positive airway pressure have an increased risk of second eye involvement.

Purpose: The aim of this study was to compare intraocular pressure (IOP) measurements using 2 portable tonometers, the Keeler Pulsair Intellipuff and the Reichert PT100, with Goldmann applanation tonometry (GAT)., Materials and Methods: Prospective cross-sectional study was conducted on normotensive and hypertensive patients recruited from the outpatient clinic of the University Hospital of Grenoble. IOP was measured using 2 portable noncontact tonometers (NCTs) and GAT in one eye of each patient in a random order. Central corneal thickness was measured with the Accutome PachPen Pachymeter. The Wilcoxon and t tests were used to compare the differences between tonometers, the Pearson and the Spearman correlation tests to evaluate the correlation among the methods, and the Bland-Altman plots to evaluate the agreement among the methods. Intraclass correlation coefficient (ICC) was used to evaluate the agreement among the methods in normotensive and hypertensive patients separately., Results: A total of 137 eyes of 137 patients were included, 104 normotensive and 33 hypertensive eyes. We found an excellent agreement between PT100 and GAT (ICC=0.77) and between Intellipuff and GAT (ICC=0.75) in normotensive patients. We found a fair to good agreement (ICC=0.67) between PT100 and GAT in hypertensive patients. The agreement we found between Intellipuff and GAT was also excellent in hypertensive patients (ICC=0.86). Both NCTs significantly overestimated IOP measurements compared with GAT in normotensive and hypertensive eyes (mean of the differences between PT100 and GAT: 1.3±2.1 and 8.1±4.6 mm Hg in normotensive and in hypertensive patients, respectively (P<0.05), and between Pulsair Intellipuff and GAT: 1.5±1.8 and 2.3±4.8 mm Hg in normotensive and in hypertensive patients, respectively (P<0.05)., Conclusions: The 2 NCTs agree well with GAT in normotensive patients. The Pulsair Intellipuff also agrees well with GAT in hypertensive patients.

Coagulase-negative staphylococci (CNS) cause the majority of post-cataract endophthalmitis, which can lead to anatomical and/or functional loss of the eye. This study reports the antibiotic susceptibilities of CNS isolates associated with acute post-cataract endophthalmitis cases and correlates antibiotic resistance with severity and outcome of infection in these patients. Clinical data (initial ocular examination, final prognosis, antibiotic treatment) and the antibiotic susceptibilities of the isolated CNS strains were obtained from 68 patients with post-surgical endophthalmitis recruited during a 7-year period by the FRench Institutional ENDophthalmitis Study (FRIENDS) group. The CNS strains displayed 100% susceptibility to vancomycin, 70% to fluoroquinolones, 83% to fosfomycin, 46% to imipenem and 18% to piperacillin. The most effective antibiotic combinations were fosfomycin plus a fluoroquinolone and imipenem plus a fluoroquinolone, which were considered adequate in 80% and 58% of patients, respectively. Methicillin resistance was significantly associated with older age (p 0.001), diabetes mellitus (p 0.004), absence of fundus visibility (p 0.06), and poor visual prognosis (p 0.03). Resistance to fluoroquinolones was significantly associated with absence of fundus visibility (p 0.05) and diabetes mellitus (p 0.02). This large prospective study demonstrates that methicillin resistance and, to a lesser extent, fluoroquinolone resistance in CNS strains causing postoperative endophthalmitis are both prevalent in France and associated with a poorer visual prognosis. These results emphasize the need for an effective surveillance of this antibiotic resistance and the development of new diagnostic tools for rapid detection for early optimization of antibiotic therapy in endophthalmitis patients., (Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Purpose: To characterize multifocal electroretinogram parameters in patients with birdshot chorioretinopathy., Methods: Twenty-eight patients with birdshot chorioretinopathy consecutively included from 2006 to 2011 were matched to 27 healthy subjects for age, axial length, and lens status. Multifocal electroretinogram was prospectively evaluated using the Vision Monitor system., Results: Birdshot chorioretinopathy eyes differed significantly from healthy eyes by a decrease in mean root mean square values (-24.7%), P1 (-17.3%) and N2 (-27.5%) amplitude, and the P1/N1 ratio (-26.3%) as well as an increase in N1 (8.7%) and P1 (5.4%) implicit time (IT). An effect of the degree of eccentricity (5 zones) was found for root mean square (P < 0.001), P1 (P < 0.001) and N2 (P < 0.001) amplitude, and P1 IT (P < 0.001). Root mean square, the P1/N1 ratio, P1 and N2 amplitudes, P1 and N1 ITs were significantly correlated with visual acuity, mean defect of visual field, foveal threshold, and color vision score. The fluorescein angiographic score was significantly correlated to N1 and N2 amplitudes and N1 IT., Conclusion: Amplitudes and ITs of the multifocal electroretinogram parameters are impaired in patients with birdshot chorioretinopathy and are well correlated with other anatomical and functional tests. Periodic testing could guide the immunosuppressive treatment.

In the first year of medical studies in France, students prepare for a highly selective entrance exam limited by numerus clausus into the second year. We have discontinued live lectures, made maximum use of new information and communication technologies and introduced tutorials in an attempt to make the first year more equitable and to personalise teaching. The reform is based on blended learning with flipped classroom organized into a four-week cycles of different activities. Each cycle corresponds to a learning module. The teachers' and students' opinions were analysed to evaluate the reforms and allow teaching methods to be adapted accordingly. The student profiles at registration and success in the exams following the reform are described. The tutorial's notes are correlated to the final scores at the entrance exam. The keys to success seem to be modified by the reform providing greater equality of opportunity between students. The factors associated to success are baccalaureate highest grades, high School Specialisation (maths, physics or earth and life sciences) and repeating the first year class. The use of blended learning allows us to face the increase of student enrolment, and to facilitate the acceptance of these pedagogical methods for both students and teachers.

Given the growing number of patients on antithrombotic therapy we are increasingly confronted with the management of this therapy before, during and after vitreoretinal surgery. In the absence of a consensus, the decision to withdraw antithrombotic therapy is based on the cardiovascular thromboembolism risk versus the theoretical risk of bleeding if the antithrombotic treatment is continued. As suggested by the literature, antiplatelet therapy (acetylsalicylic acid or clopidogrel) may be safely continued for vitreoretinal surgery, including retinal detachment repair. However, the risk/benefit ratio for patients being treated with two antiplatelet therapies is unknown. It appears that an International Normalized Ratio (INR) less than 3 for patients treated with anticoagulant therapy does not increase the perioperative risk of ocular bleeding. This risk has not been evaluated in patients treated by new antithrombotic therapies (prasugrel, ticagrelor as antiplatelet medication, or dabigatran, rivaroxaban, apixaban as anticoagulant therapy), and there is a need to study it further., (Copyright © 2014. Published by Elsevier Masson SAS.)

Purpose: To evaluate the long-term reproducibility of diurnal intraocular pressure (IOP) patterns in patients with primary open-angle glaucoma (POAG)., Design: Database study., Participants: Ninety-two patients with POAG., Methods: We reviewed the records of patients with POAG who underwent 4 diurnal IOP curve measurements 6 months apart with Goldmann applanation tonometry recorded in the sitting position at 9 am, 10 am, 11 am, noon, 2 pm, 3 pm, 4 pm, and 5 pm., Main Outcome Measures: Intervisit agreement of IOP by time point and of diurnal IOP curve parameters (mean, standard deviation, range, maximum, maximum hour, minimum, and minimum hour) was assessed using intraclass correlation coefficients (ICCs). Analyses were performed in all eyes and separately in eyes with and without hypotensive medications, and in eyes naïve and non-naïve of filtering surgery., Results: Between-visit agreement of IOP values at each time point was generally poor, with ICCs ranging from 0.26 to 0.77 in all patients (1 of 8 time points with ICC >0.75), from -0.07 to 0.60 in patients without hypotensive medications (zero time points with ICC >0.75), from 0.29 to 0.80 in patients with hypotensive medications (3 time points with ICCs >0.75), from 0.21 to 0.68 in filtering surgery-naïve patients (zero time points with ICC >0.75), and from 0.21 to 0.87 in patients with previous filtering surgeries (5 time points with ICCs >0.75). The predictive value of the first diurnal IOP curve to estimate the risk of IOP fluctuations during the 3 subsequent curves was limited (only 6.4% of the patients with an IOP range ≥30% of the mean IOP on the first curve presented similar fluctuations on the 3 subsequent curves; 77.1% of the patients who did not have an IOP range ≥30% of the mean IOP on the first curve had an IOP range ≥30% of the mean IOP on at least 1 of the 3 subsequent curves)., Conclusions: Patients with POAG do not manifest a reproducible diurnal IOP pattern from month to month. A single diurnal IOP curve in patients with POAG poorly characterizes IOP fluctuations and has limited value in clinical practice., (Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Importance: All studies of 24-hour intraocular pressure (IOP) rhythm conducted to date have used repeated IOP measurements requiring nocturnal awakenings, potentially disturbing sleep macrostructure., Objective: To evaluate the effects on sleep architecture and IOP rhythm of hourly awakening vs a contact lens sensor (CLS) to continuously monitor IOP without awakening., Design, Setting, and Participants: Cross-sectional study at a referral center of chronobiology among 12 young healthy volunteers, with a mean (SD) age of 22.3 (2.3) years., Interventions: Volunteers underwent two 24-hour IOP measurement sessions during a 2-month period. The eye order and session order were randomized. During one session, the IOP of the first eye was continuously monitored using a CLS, and the IOP of the fellow eye was measured hourly using a portable noncontact tonometer (session with nocturnal hourly awakening). During the other session, the IOP of the first eye was continuously monitored using a CLS, and the IOP of the fellow eye was not measured (session without nocturnal awakening). Overnight polysomnography was performed during the 2 sessions., Main Outcomes and Measures: A nonlinear least squares, dual-harmonic regression analysis was used to model the 24-hour IOP rhythm from the CLS data. Comparisons of acrophase, bathyphase, amplitude, and the midline estimating statistic of rhythm were used to evaluate the effect of hourly awakening on IOP rhythm. To evaluate the effects of hourly awakening on sleep architecture, comparisons of sleep structure were used, including total sleep period, rapid eye movement, wake after sleep onset, absolute and relative total sleep time, and non-rapid eye movement sleep (N1, N2, and N3)., Results: A 24-hour IOP rhythm was found in all individuals for the sessions with and without awakening (P < .05). Hourly awakening for nocturnal IOP measurements increased wake after sleep onset (P = .04) but did not seem to change total sleep time, total sleep period, sleep efficiency, or slow-wave and rapid eye movement sleep stage duration (P > .30). Hourly awakening during noncontact tonometer IOP measurements did not seem to alter the mean variables of the 24-hour IOP pattern evaluated using CLS, including signal, maximum signal, minimum signal, acrophase, and bathyphase (P > .15)., Conclusion and Relevance: The 24-hour IOP rhythms seem to be unaffected by hourly nocturnal awakening for IOP measurements in young healthy individuals.

Purpose: In non-arteritic anterior ischaemic optic neuropathy (NAAION) patients, circulatory insufficiency within the optic nerve has previously been hypothesized to be related to nocturnal systemic hypotension. The main objective of this prospective cohort study was to investigate the nyctohemeral variations in ocular perfusion pressure (OPP) in NAAION patients., Methods: In 20 patients with NAAION, the intraocular pressure (IOP) was measured using the Tono-Pen XL(™) electronic tonometer every hour for 24 hr. Blood pressure (BP) was evaluated over 24 hr. Mean OPP was calculated with the following formula: OPP sitting position = (0.74 × mean BP) - IOP and OPP lying position = (0.84 × mean BP) - IOP. A nonlinear least squares dual-harmonic regression analysis approach was used to model the 24-hr rhythms of OPP data., Results: On average, a 24-hr amplitude of 4.7 ± 2.6 mmHg was found for OPP. The patients were classified as either having a diurnal OPP rhythm (i.e. with a diurnal acrophase, 10% of the cases), a nocturnal OPP rhythm (45%) or absence of OPP rhythm (45%). Four patients had a nocturnal reduction in OPP (mean, -11%)., Conclusion: The physiological nocturnal rhythm of OPP was maintained in 45% of the NAAION patients. The nocturnal reduction in OPP seen in 20% of the patients was within the range of OPP where optic nerve blood flow autoregulation is still fully operative. A high prevalence of obstructive sleep apnoea syndrome in our population (71%) may explain the low frequency of systemic nocturnal hypotension., (© 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To evaluate the regional structure-function relationship between visual field sensitivity and retinal nerve fiber layer (RNFL) thickness and optic nerve head (ONH) measurements using spectral-domain optical coherence tomography (SD-OCT)., Methods: Prospective cross-sectional study conducted on patients with glaucoma, suspected glaucoma, and healthy subjects. Eyes were tested on Cirrus OCT and standard achromatic perimetry. RNFL thickness of 12 peripapillary 30° sectors, neuroretinal rim thickness extracted from 36 neuroretinal rim scans, and Bruch membrane opening minimum rim width (BMO-MRW)-a recently defined parameter-extracted from 36 neuroretinal rim scans were obtained. Correlations between peripapillary RNFL thickness, neuroretinal rim thickness, all six sectors of BMO-MRW, and visual field sensitivity in the six corresponding areas were evaluated using logarithmic regression analysis. Receiver operating curve areas were calculated for each RNFL, ONH, and macular ganglion cell analysis parameter., Results: We included 142 eyes of 142 subjects. The correlations (r(2)) between RNFL thickness, Cirrus-based neuroretinal rim thickness, BMO-MRW and visual field sensitivity ranged from 0.07 to 0.60, 0.15 to 0.49, and 0.24 to 0.66, respectively. The structure-function correlations were stronger with BMO-MRW than with Cirrus-based neuroretinal rim thickness. The largest areas under the receiver operating curve were seen for rim area (0.926 [95% confidence interval 0.875, 0.977]; P < 0.001) in eyes with glaucoma and for average RNFL (0.863 [0.769, 0.957]; P < 0.01) in eyes with suspected glaucoma., Conclusions: The structure-function relationship was significantly stronger with BMO-MRW than other ONH SD-OCT parameters. The best diagnostic capabilities were seen with rim area and average RNFL.

The systematic microbiological evaluation of endophthalmitis allows the confirmation of the infectious nature of the disease and the possible adaptation of treatment at the individual level and, at the collective level, the epidemiological characterization of the bacterial spectrum of endophthalmitis. Long reserved for research, the use of molecular biology techniques to complement conventional culture techniques has become important for the diagnosis of endophthalmitis in recent years. These new diagnostic techniques are particularly useful for the microbiological study of bacteria that are difficult or impossible to grow because of their intrinsic properties, their presence in only a small inoculum, their sequestration on prosthetic materials, or their inactivation by prior antibiotic treatment. These techniques are based on the polymerase chain reaction (PCR), which allows the amplification and detection of extracted bacterial deoxyribonucleic acid (DNA) that is initially present in minute quantities in an ocular sample. In practice, these conventional or real-time PCRs allow either the a priori detection of bacterial DNA (universal PCR) or the identification of a specific DNA fragment of a bacterial genus or species (specific PCR). New techniques of PCR will allow more rapid bacterial identification and also characterization of genotypic properties, such as genes of virulence or antibiotic resistance., (Copyright © 2014 Elsevier Inc. All rights reserved.)