Publications by authors named "Jean-Paul Berrod"

28 Publications

  • Page 1 of 1

Insulin inhibits inflammation-induced cone death in retinal detachment.

J Neuroinflammation 2020 Nov 26;17(1):358. Epub 2020 Nov 26.

Institut de la Vision, INSERM, UMR_S 968, CNRS, Sorbonne Université, 17 rue Moreau, F-75012, Paris, France.

Background: Rhegmatogenous retinal detachment (RD) involving the macula is a major cause of visual impairment despite high surgical success rate, mainly because of cone death. RD causes the infiltration of activated immune cells, but it is not clear whether and how infiltrating inflammatory cells contribute to cone cell loss.

Methods: Vitreous samples from patients with RD and from control patients with macular hole were analyzed to characterize the inflammatory response to RD. A mouse model of RD and retinal explants culture were then used to explore the mechanisms leading to cone death.

Results: Analysis of vitreous samples confirms that RD induces a marked inflammatory response with increased cytokine and chemokine expression in humans, which is closely mimicked by experimental murine RD. In this model, we corroborate that myeloid cells and T-lymphocytes contribute to cone loss, as the inhibition of their accumulation by Thrombospondin 1 (TSP1) increased cone survival. Using monocyte/retinal co-cultures and TSP1 treatment in RD, we demonstrate that immune cell infiltration downregulates rod-derived cone viability factor (RdCVF), which physiologically regulates glucose uptake in cones. Insulin and the insulin sensitizers rosiglitazone and metformin prevent in part the RD-induced cone loss in vivo, despite the persistence of inflammation CONCLUSION: Our results describe a new mechanism by which inflammation induces cone death in RD, likely through cone starvation due to the downregulation of RdCVF that could be reversed by insulin. Therapeutic inhibition of inflammation and stimulation of glucose availability in cones by insulin signaling might prevent RD-associated cone death until the RD can be surgically repaired and improve visual outcome after RD.

Trial Registration: ClinicalTrials.gov NCT03318588.
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http://dx.doi.org/10.1186/s12974-020-02039-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7694924PMC
November 2020

EyeSi Surgical Simulator: validation of a proficiency-based test for assessment of vitreoretinal surgical skills.

Acta Ophthalmol 2020 Oct 3. Epub 2020 Oct 3.

Department of Ophthalmology, Nancy University Hospital, Vandœuvre-lès-Nancy, France.

Purpose: To develop and investigate an evidence-based performance test for assessment of vitreoretinal surgical skills on the EyeSi Surgical Simulator.

Methods: Ten junior residents without any surgical experience, eight senior residents with prior experience in cataract surgery and five vitreoretinal surgeons were included in the study. The test consisted of seven modules and was completed twice by all groups during a single session. Validity evidence was evaluated using Messick's validity framework. Senior residents completed four additional test sessions and were retested 3 months after to assess skill acquisition and retention.

Results: Content was aligned with vitreoretinal surgical skills as evaluated by expert surgeons. Response process was ensured through standardized instruction and data collection. The test showed satisfactory internal consistency with Cronbach's α = 0.76 (internal structure) and significant discriminative ability between the residents and the experienced surgeons (relation to other variables). A pass/fail level was determined at 596 using the contrasting groups' method. Consequences of applying this standard resulted in no false positive and no false negative. Senior residents significantly improved their simulator skills over time, reaching a plateau at the fifth iteration and equalling expert performance (p = 0.420). This level of competency was retained during the post-3-month retention testing (p = 0.062).

Conclusion: We established a performance test with solid evidence for assessment of vitreoretinal surgical skills on the EyeSi Simulator and determined a benchmark criterion that may be used for future implementation of proficiency-based training for novices.
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http://dx.doi.org/10.1111/aos.14628DOI Listing
October 2020

Perioperative risk of bleeding with antithrombotic agents in macular surgery: a national, prospective, multicentre study.

Acta Ophthalmol 2020 Dec 12;98(8):e991-e997. Epub 2020 Apr 12.

Department of Ophthalmology, University Hospital, Dijon, France.

Purpose: To compare the risk of haemorrhagic complications in elective macular surgery between patients with no antithrombotic (AT) treatment (defined as patients with no history of AT therapy or who discontinued AT therapy) and patients who continued AT treatment during the surgery.

Methods: E-case report forms were prospectively recorded in a database before vitreoretinal surgery and 1 month after. Data on patient characteristics, surgical techniques, haemorrhagic complications and antithrombotic status were collected. Patients with retinal detachment, proliferative diabetic retinopathy and previous retinal haemorrhage were excluded.

Results: A total of 748 procedures (single procedure in one eye per patient) were performed between January and May 2019. Among them, 202 patients (27.0%) were treated with antithrombotic therapy at the time of surgery: 19.5% with antiplatelet agents (n = 146), 6.3% with anticoagulants (n = 47) including 3.2% (n = 24) patients treated with novel oral anticoagulants, 0.8% (n = 6) with anticoagulants and antiplatelet agents, and 0.4% (n = 3) with heparin. Overall, 92 patients (12.3%) developed one or more haemorrhagic complications, of which 63 (11.5%) and 29 (14.4%) were in the non-AT and AT group, respectively. The multivariate logistic regression model showed no difference between AT treatment groups regarding ocular bleeding complications (odds ratio [OR] 1.2, 95% confidence interval (CI) [0.7-2.2], p = 0.54).

Conclusion: No cases of uncontrolled or severe perioperative haemorrhage in patients continuing antithrombotic agents were reported in this selected population. For the majority of the patients taking antiplatelets or anticoagulants, these agents could be safely continued during macular surgery.
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http://dx.doi.org/10.1111/aos.14434DOI Listing
December 2020

OUTCOMES OF COMBINED PHACOEMULSIFICATION AND PARS PLANA VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT: A Comparative Study.

Retina 2021 Jan;41(1):68-74

Department of Ophthalmology, Nancy University Hospital, Vandœuvre-lès-Nancy, France.

Purpose: To evaluate and to compare the anatomical and functional results of phacovitrectomy and pars plana vitrectomy (PPV) alone for phakic rhegmatogenous retinal detachment.

Methods: Retrospective, comparative case series of 266 phakic eyes that underwent either combined phacovitrectomy or PPV alone for primary retinal detachment. The primary anatomical success rate, the final best-corrected visual acuity, and the refractive outcomes were analyzed.

Results: One hundred and twenty-seven eyes were included in the combined group and 139 in the PPV group. The primary anatomical success rate was 84.3% in the combined group and 89.2% in the PPV group (P = 0.311). One hundred and nine (78.4%) eyes of the PPV group required cataract removal for visual rehabilitation during the follow-up period. There was no significant difference between the two groups in terms of the mean final best-corrected visual acuity (P = 0.185) and mean visual changes (P = 0.470). Overall, combined cataract extraction resulted in a significant myopic shift compared with delayed cataract surgery (P = 0.047).

Conclusion: Combined phacoemulsification and PPV is a safe and effective procedure to treat retinal detachment. The anatomical and functional results were comparable with those obtained with PPV and delayed cataract surgery. However, the refractive outcomes were less favorable and shifted toward myopia, especially in macula-off cases.
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http://dx.doi.org/10.1097/IAE.0000000000002803DOI Listing
January 2021

Prevalence and risk factors for outer retinal layer damage after macula-off retinal detachment.

Br J Ophthalmol 2020 05 28;104(5):660-665. Epub 2019 Aug 28.

Department of Ophthalmology, University Hospital Centre Nancy, Nancy, France

Purpose: To report the prevalence of outer retinal layer (ORL) damage after macula-off rhegmatogenous retinal detachment (RRD) surgery and to determine its associated preoperative risk factors.

Methods: 253 eyes successfully operated for macula-off RRD were included in the study. The integrity of the external limiting membrane (ELM), ellipsoid zone (EZ) and cone interdigitation zone (CIZ) of the photoreceptors was assessed at 1 month and 6 months using spectral-domain optical coherence tomography. Risk factors were analysed using univariate and multivariate logistic regression. The correlation between ORL integrity and visual outcomes was also evaluated.

Results: CIZ, EZ and ELM defects were found in, respectively, 198 (93.4%) eyes, 100 (47.2%) eyes, 64 (30.2%) eyes at 1 month and in 160 (63.2%) eyes, 44 (17.4%) eyes and 18 (7.1%) eyes at 6 months. In multivariate analysis, duration of macular detachment was the only factor associated with ORL damage at 6 months (p=0.007). Best-corrected visual acuity significantly improved from 0.5±0.3 at 1 month to 0.3±0.3 logarithm of minimal angle of resolution at 6 months (p<0.001) and was strongly correlated with the number of affected bands (p<0.001).

Conclusion: Prevalence of outer retinal band defects substantially decreased through the study period, confirming the ability of photoreceptors to recover over time. However, shorter interval to surgery and better visual outcomes were significantly associated with fewer defects within the ORL at 6 months. These findings suggest that earlier surgery may limit RRD-associated photoreceptor degeneration and improve the patient's visual prognosis.
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http://dx.doi.org/10.1136/bjophthalmol-2019-314236DOI Listing
May 2020

Reply.

Am J Ophthalmol 2018 12 2;196:213. Epub 2018 Oct 2.

Nancy, France.

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http://dx.doi.org/10.1016/j.ajo.2018.08.035DOI Listing
December 2018

Reply.

Am J Ophthalmol 2018 11 1;195:244-245. Epub 2018 Sep 1.

Vandoeuvre les Nancy, France.

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http://dx.doi.org/10.1016/j.ajo.2018.07.039DOI Listing
November 2018

EYESI surgical simulator: validity evidence of the vitreoretinal modules.

Acta Ophthalmol 2019 Mar 31;97(2):e277-e282. Epub 2018 Aug 31.

Department of Ophthalmology, Nancy University Hospital, Vandœuvre-lès-Nancy, France.

Purpose: To investigate the validity of six vitreoretinal modules on the Eyesi Surgical Simulator.

Methods: Fifteen residents with no vitreoretinal experience and six trained vitreoretinal surgeons (>100 procedures per year) were included in the study. Four modules were selected in agreement with an experienced surgeon: the navigation (Nav), forceps (For), vitrector (Vit) and epiretinal membrane (ERM) peeling modules. The first level of the basic training modules (Nav1 and For1) and the first two levels of the more procedural modules (Vit1, Vit2, ERM1 and ERM2) were completed twice by both groups in the above order. The performance parameters for each task were calculated by the simulator software. The results from both iterations were recorded for analysis.

Results: Experienced vitreoretinal surgeons outperformed residents with regard to the overall score on the Nav1 (p = 0.01), For1 (p < 0.01), ERM1 (p = 0.02) and ERM2 (p = 0.04) modules. No differences in overall score were found between the two groups on the Vit1 (p = 0.17) and Vit2 modules (p = 0.26).

Conclusion: Validity for the simulator metrics was found on four vitreoretinal modules not previously investigated, with regard to construct validity, content and the response process. These exercises could be included in a future competency-based training programme that could potentially be applied in the standard ophthalmological curriculum.
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http://dx.doi.org/10.1111/aos.13910DOI Listing
March 2019

Internal Limiting Membrane Peeling in Macula-off Retinal Detachment Complicated by Grade B Proliferative Vitreoretinopathy.

Am J Ophthalmol 2018 07 3;191:1-6. Epub 2018 Apr 3.

Department of Ophthalmology, University Hospital, Nancy, France.

Purpose: To investigate the clinical benefit of internal limiting membrane (ILM) peeling as a surgical adjunct in the repair of primary retinal detachment (RD) complicated by grade B proliferative vitreoretinopathy (PVR).

Design: Retrospective, interventional, comparative case series.

Methods: Setting, study population, observationalprocedures and Main outcome measures.

Setting: Institutional.

Study Population: Seventy-five consecutive patients who underwent vitrectomy for primary macula-off RD complicated by grade B PVR.

Observational Procedures: Patients were divided into an ILM peeling (Group P) and a no ILM peeling group (Group NP).

Main Outcome Measures: Anatomic success rate, best-corrected visual acuity, and spectral-domain optical coherence tomography (SD-OCT) characteristics were collected at 1 and 6 months.

Results: In all, 37 eyes with ILM peeling were included in Group P and 38 eyes without ILM peeling were included in Group NP. The anatomic success rate after single surgery was higher in Group P (89%) than in Group NP (66%, P = .03). Mean final visual acuity was 0.41 ± 0.40 logMAR in Group P vs 0.43 ± 0.22 logMAR in Group NP (P = .82). We found no epiretinal membrane (ERM) formation in Group P, whereas 5 cases of ERM (20%) were detected in Group NP (P = .012). The 2 groups did not differ in terms of cystoid macular edema occurrence, macular thickness, or photoreceptor damage.

Conclusions: ILM peeling during vitrectomy in macula-off RD complicated by grade B PVR reduces the need for a second surgery for redetachment or macular pucker.
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http://dx.doi.org/10.1016/j.ajo.2018.03.037DOI Listing
July 2018

Visual Outcomes of Pars Plana Vitrectomy with Epiretinal Membrane Peeling in Patients with Asteroid Hyalosis: A Matched Cohort Study.

Ophthalmic Res 2017 3;58(1):35-39. Epub 2017 May 3.

Department of Ophthalmology, Nancy University Hospital, Nancy, France.

Background: The study aimed to evaluate outcomes of epiretinal membrane (ERM) peeling in patients with asteroid hyalosis (AH) and to compare them with those from controls without AH.

Methods: This is a retrospective matched cohort study of 1,104 consecutive patients who underwent surgery for ERM between January 2004 and February 2014. Patients with AH were included in the study group and were matched for preoperative visual acuity, age, gender, date of surgery, and axial length with control patients without AH selected from the same cohort. The best-corrected visual acuity (BCVA) and central macular thickness (CMT) on optical coherence tomography were measured at baseline and postoperatively with a minimum follow-up period of 12 months.

Results: A total of 44 patients were included in the AH group and 44 in the control group. The mean initial BCVA was 0.53 ± 0.21 LogMAR for the AH group vs. 0.49 ± 0.20 LogMAR for the control group, and the mean initial CMT was 419 ± 74 vs. 423 ± 75 µm, respectively. During the follow-up, no significant difference was found regarding the final BCVA at 6 months (0.23 ± 0.14 vs. 0.24 ± 0.17) LogMAR (p = 0.87) and 12 months (0.16 ± 0.09 vs. 0.17 ± 0.12) LogMAR (p = 0.92), despite a tendency toward slower visual recovery for the AH group at 1 month, with a mean BCVA of 0.36 ± 0.12 vs. 0.28 ± 0.18 LogMAR (p = 0.08). No difference was found regarding the progression of CMT at 1.6 and 12 months with a mean CMT of 396 ± 47 vs. 378 ± 55 µm (p = 0.39), 356 ± 39 vs. 365 ± 41 µm (p = 0.48), and 349 ± 68 vs. 352 ± 53 µm (p = 0.87), respectively.

Conclusion: Vitrectomy with ERM peeling in patients with AH was beneficial and showed similar functional and anatomical outcomes in both groups. AH does not seem to affect visual improvement or the complication rate after ERM peeling. Therefore, the indications for vitrectomy in case of ERM should not be prompted by the presence of AH.
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http://dx.doi.org/10.1159/000468990DOI Listing
September 2017

Intraocular Cytokine Levels in Post-Cataract Endophthalmitis and their Association with Visual Outcome.

Ocul Immunol Inflamm 2018 28;26(6):964-970. Epub 2017 Apr 28.

a Fédération de Médecine Translationnelle, Service d'Ophtalmologie , Université de Strasbourg - CHU Strasbourg , Strasbourg , France.

Purpose: The host immune reaction during endophthalmitis, studied in particular through the intraocular cytokine network, is essential for the comprehension of the disease and the development of new therapies. Therefore, the purpose of this study was to elucidate the cytokine composition of aqueous humor during endophthalmitis.

Methods: In a multicenter case-control study, forty-nine patients with postoperative endophthalmitis and 60 controls (cataract surgery) were included. Visual acuity, local inflammatory grading, medical history and intraocular levels of 27 cytokines and chemokines (measured by multiplex immunoassay) were recorded.

Results: During endophtalmitis, an increase in total cytokines was observed. The raise of Th1 cytokines was particularly noticeable. Chemokines, such as IL-8, MIP-1 β, MCP-1, G-CSF and IP-10, also increased. Pearson's correlation analyses showed a poor visual prognosis with high levels of IL-8, MCP-1 and VEGF and a low level of IL-10 at admission.

Conclusion: An increase in inflammatory cytokines is noticeable during endophthalmitis, with a particular emphasis on IL-8, MCP-1 and VEGF. Targeted anti-inflammatory and anti-VEGF treatments may be of interest in the future.
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http://dx.doi.org/10.1080/09273948.2017.1310253DOI Listing
September 2018

Postoperative Ocular Inflammation: A Single Subconjunctival Injection of XG-102 Compared to Dexamethasone Drops in a Randomized Trial.

Am J Ophthalmol 2017 Feb 1;174:76-84. Epub 2016 Nov 1.

Department of Ophthalmology, Assistance Publique-Hôpitaux Paris, Hôpital Hôtel-Dieu, Paris, France.

Purpose: To evaluate the efficacy and safety of XG-102 (brimapitide) compared to dexamethasone eye drops in the treatment of postoperative ocular inflammation.

Design: Multicenter, randomized, parallel group, double-masked, noninferiority clinical trial.

Methods: Patients who underwent anterior and posterior segments combined surgery or glaucoma surgery or complex posterior segment surgery were eligible to participate. Patients were administered a single subconjunctival injection of 250 μL XG-102 90 μg (n = 47) or 900 μg (n = 48) or placebo (n = 50) at the end of ocular surgery. Subconjunctival injection for each group (XG-102 90 μg, XG-102 900 μg, or placebo) was followed by eye drops instilled 4 times per day for 21 days with placebo, placebo, or dexamethasone solution, respectively. The primary outcome measure was anterior chamber cell grades at day 28 comparing XG-102 900 μg with dexamethasone.

Results: The anterior cell grades for both XG-102 groups were noninferior to dexamethasone (-0.054 anterior cell grade [95% confidence interval -0.350-0.242]; P < .001 for noninferiority) for XG-102 900 μg and -0.086 anterior cell grade (95% confidence interval -0.214-0.385; P = .003 for noninferiority) for XG-102 90 μg. Rescue medication was introduced for 10 (21%), 7 (15%), and 2 (4%) patients allocated to the XG-102 90 μg, XG-102 900 μg, and dexamethasone groups, respectively. The difference between XG-102 90 μg and dexamethasone was statistically significant (P = .013). The number of patients for whom adverse events were reported and the nature of the events reported was similar between the 3 treatment groups.

Conclusions: A single subconjunctival injection of XG-102 at the end of ocular surgery is noninferior to dexamethasone eye drops in the treatment of postoperative ocular inflammation.
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http://dx.doi.org/10.1016/j.ajo.2016.10.012DOI Listing
February 2017

Validity of aqueous flare measurement in predicting proliferative vitreoretinopathy in patients with rhegmatogenous retinal detachment.

Acta Ophthalmol 2017 Jun 29;95(4):e278-e283. Epub 2016 Sep 29.

Department of Ophthalmology, Nancy University Hospital, Nancy, France.

Purpose: To investigate aqueous flare as a preoperative predictor for later proliferative vitreoretinopathy (PVR) development in patients with rhegmatogenous retinal detachment (RD) and to determine the validity of this measurement in patients at low clinical risk for postoperative PVR.

Methods: This study included 100 eyes of 100 patients who underwent surgery for primary RD. Aqueous flare was determined preoperatively with a laser flare-cell meter (Kowa FM-500, Kowa Company Ltd, Tokyo, Japan). Patients were followed for at least 6 months postoperatively. Failures related to PVR were recorded for statistical analysis.

Results: Twenty eyes (20%) developed PVR postoperatively. Preoperative flare values in these eyes were significantly higher than in eyes with no redetachment (48.12 ± 61.24 versus 17.74 ± 29.63 photon counts per millisecond (pc/ms), p = 0.002). The odds ratio for PVR development with flare values >15 pc/ms was 12.3 (p < 0.0001, 95% confidence interval, 3.54-42.59). Of 54 eyes at low clinical risk for postoperative PVR, five developed PVR postoperatively. Flare values were significantly higher in these eyes (25.30 ± 7.10 pc/ms) than in eyes with no redetachment (12.44 ± 10.16 pc/ms, p = 0.008). Using logistic regression, the odds ratio of PVR redetachment risk increased by the factor 1.078 per 1 pc/ms of flare value (95% CI, 1.01-1.15).

Conclusion: Preoperative aqueous flare is a strong predictive factor for PVR redetachment. The laser flare-cell meter provides a fast and safe tool to accurately identify patients at risk for postoperative PVR, especially when clinical examination did not predict this risk.
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http://dx.doi.org/10.1111/aos.13254DOI Listing
June 2017

Early versus delayed intravitreal betamethasone as an adjuvant in the treatment of presumed postoperative endophthalmitis: a randomised trial.

Br J Ophthalmol 2016 Aug 24;100(8):1076-80. Epub 2015 Nov 24.

Department of Ophthalmology, University Hospital, Dijon, France Eye and Nutrition Research Group, CSGA, UMR1324 INRA, 6265 CNRS, Burgundy University, Dijon, France.

Aim: To compare early versus delayed intravitreal betamethasone as an adjuvant in the treatment of presumed acute postoperative endophthalmitis after phacoemulsification.

Methods: Patients with presumed postcataract surgery endophthalmitis were included in this prospective, randomised, multicentre study. On admission, patients received intravitreal vancomycin and ceftazidime, and were randomly assigned to intravitreal betamethasone injection (early-IVB) group or no immediate injection (delayed-IVB) group. After 48 h, a second intravitreal antibiotic injection associated with intravitreal betamethasone was given to all patients. In patients with severe endophthalmitis or clinical deterioration, a prompt or delayed vitrectomy was performed. The primary outcome was the proportion of patients achieving a visual acuity (VA) of 20/40 or better at 12 months. The secondary outcomes were the rate of delayed vitrectomy and the rate of complications (retinal detachment and phthisis).

Results: Ninety-seven eyes of 97 patients were included, 45 in the early-IVB group and 52 in the delayed-IVB group. Overall, 62.9% of patients achieved a VA ≥20/40 at 1 year. There was no statistically significant difference in the visual outcome between the two groups at 1 year, whatever their baseline VA or light perception or hand motion or more (p=0.55 and p=0.10, respectively). The rates of delayed vitrectomy, retinal detachment and phthisis bulbi were not significantly different between the two groups (p=0.42, p=0.37 and p=0.44, respectively).

Conclusions: Early intravitreal betamethasone had no clear advantage versus delayed injection in the management of presumed postoperative endophthalmitis.
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http://dx.doi.org/10.1136/bjophthalmol-2015-307063DOI Listing
August 2016

Author reply: To PMID 24480709.

Ophthalmology 2015 Sep;122(9):e56

Department of Ophthalmology, University Hospital, Nancy, France.

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http://dx.doi.org/10.1016/j.ophtha.2015.02.023DOI Listing
September 2015

Outcomes of epiretinal membrane surgery in highly myopic eyes: a case-control study.

Br J Ophthalmol 2015 Jun 19;99(6):859-63. Epub 2014 Dec 19.

Department of Ophthalmology, Nancy University Hospital, Nancy, France.

Aims: To evaluate the outcomes of epiretinal membrane (ERM) surgery in highly myopic eyes and to compare them with those from non-highly myopic eyes.

Methods: Retrospective nested case-control study from a cohort of 1776 consecutive patients (1776 eyes) who underwent surgery for ERM. Fifty-seven highly myopic eyes (with axial length longer than 26 mm) were included in the study group and were matched for preoperative visual acuity and duration of symptoms with 57 non-highly myopic control eyes selected from the same cohort. The best-corrected visual acuity (BCVA), the relationship between axial length and visual improvement, the central macular thickness (CMT) and the surgical complications were analysed.

Results: The mean axial length was 27.3±1.1 mm in highly myopic eyes and 23.1±1 mm in controls (p<0.001). At the 1-year final examination, the mean BCVA significantly improved from 0.62±0.23 logarithm of minimal angle of resolution (logMAR) to 0.27±0.21 logMAR in the study group (p<0.001) and from 0.61±0.22 logMAR to 0.25±0.15 logMAR in the control group (p<0.001). Similarly, the mean CMT significantly decreased in both groups (p<0.001). The two groups did not differ statistically in terms of visual and anatomical changes as well as surgical complications. There was no significant correlation between axial length and visual recovery.

Conclusions: ERM surgery resulted in similar anatomical and functional outcomes in both groups. Longer axial length does not seem to affect visual improvement and the complication rate.
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http://dx.doi.org/10.1136/bjophthalmol-2014-306027DOI Listing
June 2015

Intraocular levels of interleukin 17A (IL-17A) and IL-10 as respective determinant markers of toxoplasmosis and viral uveitis.

Clin Vaccine Immunol 2015 Jan 5;22(1):72-8. Epub 2014 Nov 5.

Institut de Parasitologie et de Pathologie Tropicale, EA 7292, Fédération de Médecine Translationnelle, Université de Strasbourg, Strasbourg, France.

Uveitis is a potentially blinding inflammatory disease. Thirty to 50% of uveitis cases are considered idiopathic. The present study sought to determine the intraocular cytokine patterns in the different etiological types of uveitis in order to better understand their immunological regulation and to determine whether the cytokine pattern may be a useful diagnostic tool. From a multicenter institutional prospective study, the clinical and biological data from patients with uveitis of various etiologies, determined after a complete workup, were compared with those from a control group of cataract patients. A multiplex assay was used to assess the profiles of 27 cytokines and chemokines in aqueous humor samples from these patients. In total, 62 patients with infectious or noninfectious uveitis and 88 controls were included. After a complete workup, the cause of uveitis remained unknown in 25 patients (40% idiopathic uveitis). Interleukin 1β (IL-1β) levels were markedly increased in viral uveitis, as were IL-10 levels, whereas IL-17A levels were augmented in toxoplasmic uveitis. Based on the cytokine pattern, the patients were reassigned to specific groups. At the end of the study, the diagnosis of idiopathic uveitis was still valid in only 11 patients (18%). The observation that some markers are specific to certain diseases enables a better understanding of the disease pathogenesis and paves the way for new diagnostic methods aimed to identify inflammatory markers, which may perhaps be targeted by therapy.
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http://dx.doi.org/10.1128/CVI.00423-14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4278934PMC
January 2015

Outcomes of macular hole surgery with short-duration positioning in highly myopic eyes: a case-control study.

Ophthalmology 2014 Jun 27;121(6):1263-8. Epub 2014 Jan 27.

Department of Ophthalmology, Nancy University Hospital, Nancy, France.

Purpose: To evaluate the outcomes of macular hole (MH) surgery with 3-day prone positioning in highly myopic eyes and to compare them with those from non-highly myopic eyes.

Design: Retrospective nested case-control study from a cohort of 496 consecutive patients (496 eyes) who underwent surgery for MH.

Participants: Forty-seven highly myopic eyes (with axial length >26 mm) were included in the study group and were matched for MH size and duration of symptoms with 47 non-highly myopic control eyes selected from the same cohort.

Methods: All patients underwent pars plana vitrectomy, internal limiting membrane peeling, and 17% hexafluoroethane gas filling. Patients then were advised to maintain strict face-down positioning for 3 days only and to avoid the supine position during the night for a minimum of 1 week.

Main Outcome Measures: The MH closure rate, the relationship between axial length and closure rate, the best-corrected visual acuity (BCVA), and the surgical complications were analyzed.

Results: The mean axial length was 28.5±2.2 mm in highly myopic eyes and 23.3±1.1 mm in controls (P < 0.001). Closure of the MH was achieved in 39 of 47 eyes (83%) in the study group and in 45 of 47 eyes (95.7%) in the control group (P = 0.045). Anatomic outcomes tended to decrease when axial length increased (P = 0.066). Mean BCVA improved in both groups (0.41±0.39 logarithm of the minimal angle of resolution [logMAR] vs. 0.68±0.34 logMAR) but was significantly lower in highly myopic eyes (P < 0.001). Retinal detachment occurred in 8.5% of highly myopic patients versus 2.1% of controls, but the difference was not significant.

Conclusions: Macular hole surgery with 3-day postoperative positioning in highly myopic eyes resulted in satisfactory anatomic and functional outcomes. However, the MH closure rate and mean improvement of visual acuity were less favorable than those in control eyes. Longer axial length may increase the risk of anatomic failure.
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http://dx.doi.org/10.1016/j.ophtha.2013.12.005DOI Listing
June 2014

Primary vitrectomy for the treatment of retinal detachment in highly myopic eyes with axial length over 30 mm.

Eur J Ophthalmol 2013 Jul-Aug;23(4):564-70. Epub 2013 Mar 28.

Department of Ophthalmology, University Hospital, Dijon, France.

Objective: To assess the functional and anatomical outcome of primary vitrectomy without scleral buckling for rhegmatogenous retinal detachment (RRD) in highly myopic eyes with axial length over 30 mm.

Methods: In this retrospective, interventional case series, we evaluated the outcome of primary vitrectomy without scleral buckling in 67 highly myopic patients (67 eyes) with RRD. Anatomical success rate was defined as complete reattachment of the retina without definitive silicone oil tamponade.

Results: Retinal reattachment was achieved with a single surgery in 49 of 67 eyes (73.1%) and after 2 or 3 surgeries in 54 eyes (80.6%). The characteristics of retinal tears did not influence the final outcome. Multivariate analysis revealed that a longer axial length was the only factor associated with a higher failure rate, p = 0.0061. Mean preoperative visual acuity significantly increased after surgery, p = 0.0003.

Conclusion: The study demonstrated fair efficacy of vitrectomy and fluid-gas exchange in the treatment of retinal detachment in highly myopic eyes with an axial length over 30 mm.
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http://dx.doi.org/10.5301/ejo.5000275DOI Listing
February 2014

[Age related macular degeneration].

Rev Prat 2011 Feb;61(2):159-64

Service d'ophtalmologie A, Hôpital central, CHU de Nancy, CO no 34 54035 Nancy Cedex.

Age-related macular degeneration (ARMD) is a multifactorial disease caused by a combination of genetic and environmental factors. It is the first cause of blindness in patients over 50 in the western world. The disease has been traditionally classified into early and late stages with dry (atrophic) and wet (neovascular) forms: neovascular form is characterized by new blood vessels development under the macula (choroidal neovascularisation) which lead to a rapid decline of vision associated with metamorphopsia and requiring an urgent ophtalmological examination. Optical coherence tomography is now one of the most important part of the examination for diagnosis and treatment. Patient with age related maculopathy should consider taking a dietary supplement such that used in AREDS. The treatment of the wet ARMD has largely beneficied since year 2006 of anti-VEGF (vascular endothelial growth factor) molecules such as ranibizumab or bevacizumab given as repeated intravitreal injections. A systematic follow up each 4 to 8 week in required for several years. There is no effective treatment at the moment for dry AMD. For patients with binocular visual acuity under 60/200 rehabilitation includes low vision specialist, vision aids and psychological support.
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February 2011

Macular hole in a newborn associated with forceps delivery.

J Pediatr Ophthalmol Strabismus 2010 Dec 22;47 Online:e1-3. Epub 2010 Dec 22.

Ophtalmology A, Service Ophtalmology Hopital Central, Nancy, France.

A newborn who had familial high myopia presented with bilateral dense vitreous hemorrhage after forceps delivery. Vitrectomy in the right eye revealed a macular hole surrounded by pigmented cells. After subsequent surgery, the macular hole healed and remained closed during 10 years of follow-up, but profound amblyopia persisted. Macular hole is a possible complication of forceps delivery. Vitrectomy associated with inner limiting membrane peeling and gas tamponade was effective in closing macular hole in a newborn but was unable to prevent amblyopia.
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http://dx.doi.org/10.3928/01913913-20101217-02DOI Listing
December 2010

A randomized controlled trial of alleviated positioning after small macular hole surgery.

Ophthalmology 2011 Jan 29;118(1):150-5. Epub 2010 Oct 29.

Service d'Ophtalmologie, Hôpital Lariboisière, AP-HP, Université Paris Diderot, Paris, France.

Objective: To establish whether the success rate of surgery for small idiopathic macular holes (diameter, ≤ 400 μm) is significantly reduced if facedown positioning is replaced by simply taking care to avoid the supine position.

Design: Randomized, controlled, parallel-assignment, open-label, interventional, multicenter clinical trial.

Participants: Sixty-nine patients from 6 specialized vitreoretinal units, randomized into 2 parallel groups and followed up after surgery for 3 months.

Methods: All patients underwent pars plana vitrectomy, peeling of any epiretinal membrane, and 17% C₂F₆ gas filling. Patients then were advised randomly to observe either strict facedown positioning for 22 of 24 hours or simply to avoid the supine position for 10 days.

Main Outcome Measures: The primary outcome measure was the rate of anatomic closure 3 months after surgery. Main secondary measurements included Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity, progression of cataract, and frequency of complications.

Results: The mean size of macular holes was approximately 300 μm in both groups. Closure rates were more than 90% in both groups: 32 (91.4%) of 34 eyes in the alleviated positioning group versus 32 (94.1%) of 35 eyes in the facedown positioning group (lower margin of 95% confidence interval of difference, -14.88%). The ETDRS scores at 3 months increased in both groups by 10.23 ± 14.64 and 10.52 ± 14.54 letters, respectively. Progression of cataract and the rate of other complications were not significantly different in the 2 groups.

Conclusions: The success rate of surgery for idiopathic macular holes of 400 μm or smaller is not significantly reduced if facedown positioning is replaced by simply taking care to avoid the supine position. These macular holes can be treated by streamlined surgery, that is, with no internal limiting membrane peeling and no facedown positioning (only avoidance of the supine position) with a closure rate of more than 90% and a mean gain in visual acuity of more than 2 ETDRS lines at 3 months.
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http://dx.doi.org/10.1016/j.ophtha.2010.04.040DOI Listing
January 2011

Macular hole surgery and cataract extraction: combined vs consecutive surgery.

Am J Ophthalmol 2010 Sep 7;150(3):387-91. Epub 2010 Jul 7.

Department of Ophthalmology University Hospital, Rue du Faubourg Raines, Dijon, France.

Purpose: To compare the functional and the anatomic outcomes of a combined surgery and consecutive surgery for macular hole and cataract extraction.

Design: Multicenter, retrospective, comparative case series.

Patients: One hundred twenty patients (120 eyes) with an idiopathic macular hole and cataract were operated on in 1 or 2 sessions in 2 academic centers, Dijon University Hospital and Nancy University Hospital. Combined surgery (n = 64) and consecutive surgery (n = 56) were performed between 2006 and 2007. All patients underwent pars plana vitrectomy with internal limiting membrane peeling and gas tamponade. Cataract extraction was performed with phacoemulsification followed by a posterior chamber intraocular lens implantation. The main outcome measures were near and far visual acuity at 6 and 12 months, and the rate of closure of macular hole evaluated with optical coherence tomography.

Results: After a 12-month follow-up, the postoperative best-corrected visual acuities significantly improved in both the combined and the consecutive surgery groups (near and far vision in both groups, P < .0001). However the improvement of far visual acuity was not significant in the consecutive surgery group at 6 months (P = .06) while such an improvement was observed in the combined surgery group (P < .0001). The rates of closure, 100% and 96% in the combined and the consecutive groups respectively, and the complications did not differ significantly between groups.

Conclusion: Both combined and consecutive surgeries are safe and effective methods to treat macular hole and cataract with equivalent functional and anatomic results in both procedures. However, combined surgery shortened the delay for visual recovery.
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http://dx.doi.org/10.1016/j.ajo.2010.04.008DOI Listing
September 2010

Idiopathic epiretinal macular membrane and cataract extraction: combined versus consecutive surgery.

Am J Ophthalmol 2010 Feb;149(2):302-6

Department of Ophthalmology University Hospital, Rue du Faubourg Raines, Dijon, France.

Purpose: To assess the functional and anatomic outcomes of cataract and idiopathic epiretinal macular membrane extraction in combined and consecutive surgeries.

Design: Multicenter, retrospective, comparative case series.

Methods: One hundred seventy-four patients (174 eyes) with an epiretinal macular membrane (ERM) and cataract were operated on in 1 or 2 sessions in 2 academic centers, Dijon University Hospital and Nancy University Hospital. Combined surgery (n = 109) and consecutive surgery (n = 65) were performed between 2005 and 2006. All patients underwent ERM and internal limiting membrane removal. Cataract extraction was performed with phacoemulsification followed by a posterior chamber intraocular lens implantation. The main outcome measures were near and far visual acuity and central macular thickness evaluated with optical coherence tomography.

Results: After a 12-month follow-up, the postoperative best-corrected visual acuities significantly improved in both the combined and the consecutive surgery groups (near and far vision in both groups, P < .0001). Similarly, the postoperative macular thickness significantly decreased in both groups (P < .0001). We noted no statistical differences between the visual acuity improvement in both groups (near vision, P= .54; far vision, P = .38). However, visual acuity recovery was quicker in the combined surgery group.

Conclusions: Combined and consecutive surgeries are effective procedures to treat idiopathic ERM. The functional and anatomic results are equivalent in both procedures.
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http://dx.doi.org/10.1016/j.ajo.2009.09.011DOI Listing
February 2010

Long-term outcome of idiopathic macular hole surgery.

Am J Ophthalmol 2010 Jan 20;149(1):120-6. Epub 2009 Oct 20.

Department of Ophthalmology, University Hospital, Dijon, France.

Purpose: To evaluate the role of preoperative macular hole (MH) diameter, cataract surgery, and cystoid macular edema (CME) in the reopening of idiopathic macular hole (IMH) after initially successful surgery.

Design: Multicenter, retrospective, comparative case series.

Methods: One hundred and thirty patients (135 eyes) with stage 2, 3, or 4 IMH were included after successful IMH repair at Dijon University Hospital or Nancy University Hospital. The eyes were separated into 4 groups according to the lens status: group 1, vitrectomy in pseudophakic eyes; group 2, vitrectomy and cataract extraction as a combined procedure; group 3, vitrectomy followed by cataract extraction; group 4, vitrectomy on eyes that remained phakic. All patients underwent a complete vitrectomy with retinal inner limiting membrane peeling and intraocular gas tamponade. The main outcome measures were IMH closure rate and best-corrected visual acuity.

Results: Mean duration of symptoms was 8.6 +/- 7.6 months. The follow-up was 37 +/- 8.6 months (range, 30 to 67 months). The mean preoperative IMH diameter was 454 +/- 191 mum. No MH reopened during the follow-up after the initial vitreous surgery. Seven cases of CME were observed (1 in groups 1 and 2; 5 in group 3), and cataract surgery was performed in the 53 patients in group 3 with a mean delay of 11.6 months.

Conclusions: Cataract extraction, CME, or preoperative MH diameter measured by optical coherence tomography were not identified as risk factors for IMH reopening.
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http://dx.doi.org/10.1016/j.ajo.2009.08.003DOI Listing
January 2010

The learning curve for primary vitrectomy without scleral buckling for pseudophakic retinal detachment.

Graefes Arch Clin Exp Ophthalmol 2009 Mar 26;247(3):319-24. Epub 2008 Nov 26.

Department of Ophthalmology, University Hospital, Dijon, France.

Background: To assess the functional and anatomical outcome of primary vitrectomy without scleral buckling for rhegmatogenous retinal detachment (RRD) in pseudophakic patients and to present the learning curve for this surgery in less experienced surgeons.

Methods: We reviewed the charts of pseudophakic patients treated with primary vitrectomy without scleral buckling for a rhegmatogenous retinal detachment with PVR
Results: First, 133 patient charts with a minimum follow-up of 6 months were included. Retinal reattachment was achieved with a single surgery in 75.2% for all surgeons. This rate was 80.9% for more experienced surgeons compared to 70% for less experienced surgeons (p = 0.37). In another series of 239 patients operated on by less experienced surgeons, the success rate obtained at the beginning of the training period for less experienced surgeons significantly increased after 2 years (from 66.7% to 80%, p < 0.049).

Conclusion: Primary vitrectomy without scleral buckling is an effective procedure to treat pseudophakic retinal detachment. Less experienced surgeons need sufficient time to achieve acceptable success rates, reflecting the learning curve for this procedure.
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http://dx.doi.org/10.1007/s00417-008-0997-yDOI Listing
March 2009

Comparison of face-down and seated position after idiopathic macular hole surgery: a randomized clinical trial.

Am J Ophthalmol 2008 Jul 28;146(1):128-134. Epub 2008 Apr 28.

Department of Ophthalmology, University Hospital Dijon, Rue du Faubourg Raines, Dijon, France.

Purpose: To compare two therapeutic modalities on anatomic and functional results after idiopathic macular hole (MH) surgery: seated vs face-down position.

Design: Multicenter, prospective, randomized trial.

Methods:

Setting: University Hospital Dijon and University Hospital Nancy.

Patients: One hundred and forty-four patients (150 eyes) were enrolled and randomly separated into two groups for postoperative position: for the 72 eyes in the P0 group and the 78 eyes in the P1 group, the patients were asked to keep the seated (P0 group) and the face-down position (P1 group) after the idiopathic MH surgery.

Intervention: All patients underwent a complete vitrectomy with a fluid-air exchange and an intraocular gas tamponade. After the surgery, patients were asked to keep one of the two randomly chosen positions for five days.

Main Outcome Measures: Best-corrected visual acuity (VA), fundus examination, and macular optical coherence tomography were performed before and six months after surgery.

Results: The overall anatomic success rate was 92.7%. The idiopathic MH sealed in 63 of 72 P0 eyes (87.5%) and 76 of 78 P1 eyes (97.4%) (P = .027). The mean VA increased from 0.86 to 0.61 logMAR (0.88 to 0.61 in P0 and 0.84 to 0.60 in P1). However, in a post hoc analysis based on the size of the idiopathic MH, the success rate in idiopathic MHs smaller than 400 microm was not influenced by the postoperative position (P = .47).

Conclusions: A face-down postoperative position is highly recommended in holes larger than 400 microm. The size of the idiopathic MH seems to be an important factor affecting outcome.
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http://dx.doi.org/10.1016/j.ajo.2008.02.029DOI Listing
July 2008

Incidence of retinal detachment after macular surgery: a retrospective study of 634 cases.

Br J Ophthalmol 2007 Oct 23;91(10):1327-30. Epub 2007 May 23.

Department of Ophthalmology, Univeristy Hospital Dijon, Dijon, France.

Aims: To evaluate the rate of retinal detachment after macular surgery.

Methods: A retrospective non-randomised study of 634 macular surgery procedures was undertaken in two academic centres. Idiopathic macular hole (IMH) surgery (n = 272) and epiretinal membrane (ERM) surgery (n = 362) were performed between 2000 and 2003. We noted the anatomical and functional results of these procedures and we studied serious complications excluding cataract.

Results: Minimum follow up was 1 year. No retinal detachment (RD) occurred in patients presenting with an intraoperative or preoperative successfully treated retinal break (RB). The rate of RD occurring after IMH surgery was higher than after the ERM surgical procedure (6.6% vs 2.5%, p = 0.02). The rate of RD was higher in patients presenting with stage 2 and 3 IMH than with stage 4 IMH. However, lens status as well as preoperatively treated RD did not influence the rate of RD after macular surgery.

Conclusion: Retinal detachment remains the most common serious complication of macular surgery. Surgical detachment of the posterior vitreous face and associated peripheral retina anomaly seem to increase the rate of this complication. Careful examination of the peripheral retina is a key issue in preventing retinal detachment occurring after macular surgery.
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http://dx.doi.org/10.1136/bjo.2007.115162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2001011PMC
October 2007