Publications by authors named "Thibaud Mathis"

69 Publications

Real-World Experience with Brolucizumab in Wet Age-Related Macular Degeneration: The REBA Study.

J Clin Med 2021 Jun 23;10(13). Epub 2021 Jun 23.

Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 69004 Lyon, France.

The aim of the present study was to determine the efficacy and safety of intravitreal brolucizumab therapy for neovascular age-related macular degeneration (AMD) in the real-world setting. The REBA study (real-world experience with brolucizumab in wet AMD) was a retrospective, observational, multicentric study that included 78 consecutive patients (105 eyes), with neovascular AMD, who received brolucizumab therapy. Both treatment-naive and switch-therapy patients were included. Switch therapy was based either on fluid recurrence, fluid recalcitrance, or inability to extend beyond q4/q6. All relevant data were collected. The primary outcome measure was change in best-corrected visual acuity (BCVA) over time. Secondary outcome measures included determination of change in central subfield thickness (CST) and complications. The mean baseline BCVA was 49.4 ± 5.4 letters and 40 ± 3.2 letters, and corresponding mean BCVA gain was +11.9 ± 3.9 letters ( = 0.011) and +10.4 ± 4.8 letters ( = 0.014) in the treatment-naive and switch-therapy groups, respectively. The change in CST was significantly decreased in the treatment-naive ( = 0.021) and the switch-therapy ( = 0.013) groups. The mean follow-up was 10.4 months in both groups. One patient in the switch-therapy group developed vascular occlusion and another a macular hole after the fifth brolucizumab injection. Both patients recovered uneventfully. In conclusion, patients showed a very good anatomical and functional response to brolucizumab therapy in the real world, regardless of prior treatment status, until the end of the follow-up period. Two significant untoward events were noted.
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http://dx.doi.org/10.3390/jcm10132758DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8268719PMC
June 2021

ALPK1 Gene Mutations Drive Autoinflammation with Ectodermal Dysplasia and Progressive Vision Loss.

J Clin Immunol 2021 Jun 22. Epub 2021 Jun 22.

Institute for Neurosciences of Montpellier U1051, National Center in Rare Diseases, Genetics of Sensory Diseases, Montpellier University Hospital, University of Montpellier, Montpellier, France.

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http://dx.doi.org/10.1007/s10875-021-01087-3DOI Listing
June 2021

Brolucizumab for Choroidal Neovascular Membrane with Pigment Epithelial Tear and Subretinal Fluid.

J Clin Med 2021 May 30;10(11). Epub 2021 May 30.

Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 69004 Lyon, France.

The aim of this study was to determine the utility of brolucizumab in the management of choroidal neovessels (CNV) with a retinal pigment epithelial (RPE) tear and subretinal fluid. We used a case series of patients with CNV who developed an RPE tear either spontaneously or following an intravitreal injection. All patients received intravitreal brolucizumab as primary or switch therapy. Appropriate data were collected. Follow-up was one year. The paired t-test was used to determine the significance of the results. The primary outcome measure was the change in best corrected visual acuity (BCVA). Secondary outcome measures were the change in subretinal fluid and complications, if any. A total of five patients were included in the analysis. The age range was 67-74 years and baseline BCVA was from 20/80 to 20/100. On average, all patients showed improvement in BCVA ( = 0.012) and also showed a significant anatomical improvement ( = 0.03). None of the patients had any complications, and all patients responded to additional anti-VEGF injections. In conclusion, all patients showed significant visual and anatomical improvement with brolucizumab; no complications were noted. All patients, including those who received switch, demonstrated a favorable anatomical and visual response to intravitreal brolucizumab without safety concerns.
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http://dx.doi.org/10.3390/jcm10112425DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8197900PMC
May 2021

Reply to re unexpected amaurosis occurring after peribulbar anesthesia: Exploring the causes in two cases.

Eur J Ophthalmol 2021 May 29:11206721211019584. Epub 2021 May 29.

Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon 1, Lyon, France.

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http://dx.doi.org/10.1177/11206721211019584DOI Listing
May 2021

Early Predictive Factors of Visual Loss at 1 Year in Neovascular Age-Related Macular Degeneration under Anti-Vascular Endothelial Growth Factor.

Ophthalmol Retina 2021 May 13. Epub 2021 May 13.

Service d'Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Université Lyon 1, Lyon, France; UMR-CNRS 5510 Matéis, Villeurbane, France.

Purpose: To evaluate early predictive factors of visual loss in patients treated with anti-vascular endothelial growth factor (VEGF) injections under an as-needed regimen for neovascular age-related macular degeneration (AMD).

Design: Post hoc analysis from the randomized controlled trial Groupe d'Evaluation Français Avastin versus Lucentis (GEFAL).

Participants: A total of 393 patients with neovascular AMD.

Methods: The present analysis is based on 1-year data from patients included in the study. Patients were separately categorized according to the best-corrected visual acuity (BCVA) change at 3 months and 1 year into 3 trajectories: (1) patients with no vision loss ≥5 letters at 3 months and 1 year (absence of loss ≥5 letters); (2) patients with no vision loss ≥5 letters at 3 months but loss ≥5 letters at 1 year (secondary loss ≥5 letters); and (3) patients with vision loss ≥5 letters at 3 months and 1 year (initial loss ≥5 letters).

Main Outcome Measures: The following factors were evaluated at baseline and 3 months: age, sex, BCVA, presence of fluid, central macular thickness, angiographic choroidal neovascularization (CNV) subtype, CNV area measured in disc area on fluorescein angiography, and number of intravitreal injections.

Results: An absence of loss ≥5 letters was found in 225 patients (57.3%), a secondary loss ≥5 letters after 3 months was found in 109 patients (27.7%), and an initial loss ≥5 letters was found in 59 patients (15%). Baseline characteristics were comparable among the 3 groups except for the total CNV area, which was larger in the initial and secondary loss groups (P = 0.0412). At 3 months, a significant association was found between presence of subretinal fluid (SRF) (P = 0.0318) and vision loss ≥5 letters, and an even stronger significant association between the presence of intraretinal fluid (IRF) (P = 0.0066) and vision loss ≥5 letters.

Conclusions: In the present study, we found that a large CNV area at baseline was significantly associated with initial or secondary loss of visual acuity ≥5 letters despite anti-VEGF injection. The presence of fluid, both SRF and IRF, at 3 months was found in patients with poorer trajectories.
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http://dx.doi.org/10.1016/j.oret.2021.04.015DOI Listing
May 2021

Retinal Vascularization Analysis on Optical Coherence Tomography Angiography before and after Intraretinal or Subretinal Fluid Resorption in Exudative Age-Related Macular Degeneration: A Pilot Study.

J Clin Med 2021 Apr 6;10(7). Epub 2021 Apr 6.

Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 69004 Lyon, France.

The aim was to analyze the variations in macular vascularization on optical coherence tomography angiography (OCTA) according to the presence of intraretinal fluid (IRF) induced by exudative age-related macular degeneration (AMD). We included exudative AMD patients with IRF and/or subretinal fluid (SRF) and age-matched control eyes. All patients underwent a macular 6 × 6 mm swept-source OCTA. The mean perfusion density (MPD) and mean vascular density (MVD) were calculated in the superficial (SCP) and the deep (DCP) capillary plexus at two timepoints: during an episode of exudation (T0) and after its total resorption (T1). A total of 22 eyes in the IRF ± SRF group, 11 eyes in the SRF group and 11 eyes in the healthy group were analyzed. At T0, the IRF ± SRF group showed significantly lower MPD and MVD than healthy eyes in the SCP ( < 0.001) and DCP ( < 0.001). At T1, MPD and MVD significantly increased from T0 in the SCP ( = 0.027 and = 0.0093) and DCP ( = 0.013 and = 0.046) but remained statistically lower than in the healthy eyes. For the SRF group, only the DCP showed significantly lower MPD ( = 0.012) and MVD ( = 0.046) in comparison to the healthy eyes at T0. The present study shows that retinal vascular changes do occur in the case of exudative AMD.
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http://dx.doi.org/10.3390/jcm10071524DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8038669PMC
April 2021

Therapeutic drug monitoring guides the management of patients with chronic non-infectious uveitis treated with adalimumab: a retrospective study.

Br J Ophthalmol 2021 Apr 19. Epub 2021 Apr 19.

Internal Medicine, Hopital de la Croix-Rousse Service de Medecine Interne, Lyon, France

Aim: To assess the relevance of therapeutic drug monitoring (TDM) of adalimumab (ADA) treatment for the control of intraocular inflammation and treatment adjustment in chronic non-infectious uveitis (CNIU).

Methods: Retrospective study of CNIU patients treated with ADA and for whom at least one dosage of serum ADA level and an antibodies against ADA (AAA) serology were performed, between June 2003 and July 2019.

Results: A total of 44 ADA-treated patients benefited from a TDM. A total of 48/79 (61%) TDM were performed in responders, 11/79 (14%) in primary non-responders, and 20/79 (25%) in secondary non-responders. Responders had significantly higher ADA levels than non-responders (p=0.0004). AAA were detectable in six patients, they were primary non-responders (n=2), secondary non-responders (n=3) or responders (n=1). In the five non-responders and immunised patients, ADA was switched (to golimumab or methotrexate). Among non-responders, TDM led to an increased frequency of injections 12/31 (38%), increased dose 1/31 (3%) and switch of treatment 10/31 (32%) (one missing data). No modification of biotherapy was performed 7/31 (22%) and only local or oral corticotherapy was adjusted. In 24/31 cases of therapeutic adjustment in non-responders, an improvement was observed in 87% of cases. Among responders for whom the ADA level was above the efficacy threshold, the frequency of injections was decreased for 15/31 (48.4%) cases and no relapse was observed in 12/15 (80%) cases.

Conclusion: TDM of ADA treatment proved relevant to provide CNIU patients with a personalised and optimised treatment course (in terms of frequency and type of drug).
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http://dx.doi.org/10.1136/bjophthalmol-2021-319072DOI Listing
April 2021

Endogenous endophthalmitis in the setting of Covid-19 infection: A Case Series.

Retina 2021 Mar 9. Epub 2021 Mar 9.

Alphavision Augenarztpraxis, Bremerhaven, Germany Sudhalkar Eye Hospital and Retina Centre, Baroda, India Dept. of Ophthalmology, Dr Jose E. Gonzalez Autonomous University of Nuevo Leon. Universitat Autonoma de Barcelona, Barcelona, Spain ASG Group Of Hospitals, Udaipur, India Service d'Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Université Lyon 1, Lyon, France Laboratoire UMR-CNRS 5510 Matéis, Université Lyon 1, Villeurbane, France.

Purpose: To describe endogenous endophthalmitis in the setting of Covid-19 pneumonia.

Methods: Patients recovering from Covid-19 pneumonia who presented to our department with any or all of the following complaints: pain, watering, redness and decreased vision were identified. All relevant data were collected for analysis.

Results: Three patients with endogenous endophthalmitis were identified. All patients had been treated for Covid-19 pneumonia and had received Remdesivir and systemic steroids therefor; 2/3 received tocilizumab. All patients received vitreous biopsy, vitrectomy and intraocular antibiotic injection. Patient 1 demonstrated K.pneumoniae in blood culture, K.pneumoniae and E.coli in urine culture, and K.pneumoniae in vitreous fluid, while patients 2 and 3 demonstrated S.maltophilia and Methicillin Resistant S.Aureus in the blood and nasopharyngeal culture respectively. Correspondingly, the same organism was cultured from vitreous in patients 2 and 3. The visual acuity at last follow up in patients 1-3 was 20/100, 20/80 and 20/40 respectively. The probable source of infection was identified in each as renal calculi, dental caries and the pharynx respectively. Real time polymerase chain reaction demonstrated the presence of SARS CoV-2 in the vitreous fluid of patient 1.

Conclusion: We report good outcomes of early intervention for endogenous endophthalmitis in the setting of Covid-19 infection. We also document the presence of SARS-CoV-2 in vitreous.
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http://dx.doi.org/10.1097/IAE.0000000000003168DOI Listing
March 2021

A prospective multicentre study of intravitreal injections and ocular surface in 219 patients: IVIS study.

Acta Ophthalmol 2021 Mar 18. Epub 2021 Mar 18.

Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France.

Purpose: To assess the impact of intravitreal injections (IVTI) on ocular surface of patients treated with multiple injections.

Methods: Prospective, tricentric study conducted in patients treated with unilateral IVTI. An asepsis protocol with povidone-iodine was used for all patients during IVTI. The primary endpoint was the difference between the pre-IVTI Ocular Surface Disease Index (OSDI 1) score and that measured on day one (D1) post-IVTI (OSDI 2). Secondary endpoints were the evaluation of predictive factors for OSDI scores, pain assessment on D1, and the Lacrydiag® analysis of tears from the injected eye versus contralateral eye before IVTI.

Results: Two hundred and nineteen patients with a mean age of 75.9 ± 10 years were included. The mean OSDI2-OSDI1 difference was 19.2 ± 20.6 (p < 0.001). The mean noninvasive tear break-up time was 6.41 ± 4.59 seconds in the injected eye versus 7.36 ± 4.36 seconds in the contralateral eye (p < 0.001). In the multivariate analysis, the factors significantly associated with the OSDI 2 score were the OSDI 1 score (p < 0.001), the pain score on D1 (p < 0.001) the number of instilled glaucoma eye drop (p = 0.01) and a centre effect (centres 2 and 3 versus centre 1, p < 0.001).

Conclusion: Our results confirm the impairment of the ocular surface and quality of life immediately after an IVTI. These results suggest 3 levels of action to improve the immediate tolerance: improving the basal status of the ocular surface, reducing the contact time with povidone-iodine that might be toxic to the surface, and improving immediate post-IVTI treatment.
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http://dx.doi.org/10.1111/aos.14797DOI Listing
March 2021

Visual Acuity Gain Profiles and Anatomical Prognosis Factors in Patients with Drug-Naive Diabetic Macular Edema Treated with Dexamethasone Implant: The NAVEDEX Study.

Pharmaceutics 2021 Feb 1;13(2). Epub 2021 Feb 1.

Department of Ophthalmology, Croix-Rousse University Hospital, 69004 Lyon, France.

The purpose of this study is to evaluate the visual acuity (VA) gain profiles between patients with drug-naive diabetic macular edema (DME) treated by dexamethasone implant (DEX-implant) and assess the baseline anatomical and functional factors that could influence the response to the treatment in real-life conditions. A retrospective, multi-center observational study included 129 eyes with drug-naive DME treated by DEX-implant. The Median follow-up was 13 months. Two groups of VA gain trajectories were identified-Group A, with 71% ( = 96) of patients whose average VA gain was less than five letters and Group B, with 29% ( = 33) of patients with an average gain of 20 letters. The probability of belonging to Group B was significantly higher in patients with baseline VA < 37 letters ( = 0.001). Ellipsoid zone alterations (EZAs) or disorganization of retinal inner layers (DRILs) were associated with a lower final VA (53.0 letters versus 66.4, = 0.002) but without a significant difference in VA gain (4.9 letters versus 6.8, = 0.582). Despite a low baseline VA, this subgroup of patients tends to have greater visual gain, encouraging treatment with DEX-implant in such advanced-stage disease. However, some baseline anatomic parameters, such as the presence of EZAs or DRILs, negatively influenced final vision.
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http://dx.doi.org/10.3390/pharmaceutics13020194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7912784PMC
February 2021

Current intravitreal therapy and ocular hypertension: A review.

Indian J Ophthalmol 2021 02;69(2):236-243

MS Sudhalkar Medical Research Foundation, Baroda, India.

To determine the effect of commonly used intravitreal agents on immediate and long-term IOP elevations and their association, if any, with glaucoma. Literature searches in PubMed and the Cochrane databased in January 2020 yielded 407 individual articles. Of these, 87 were selected for review based on our inclusion criteria. Based on the evidence provided, 20 were assigned level I, 27 level II, and 22 level III. Eight articles were rejected because of poor quality, insufficient clarity, or irrelevance based on standardized protocols set out by the American Academy of Ophthalmology. The studies that reported on short-term IOP elevation (i.e., between 0 and 60 min) showed that an immediate increase in IOP is seen in all patients who receive anti-VEGF agents or triamcinolone acetonide when measured between 0 and 30 min of intravitreal injection and that the IOP elevation decreases over time. The data on long-term IOP elevation were mixed; Pretreatment with glaucoma medications, anterior chamber tap, vitreous reflux, longer intervals between injections, and longer axial lengths were associated with lower IOP elevations after injection of anti-VEGF agents, while the position of the implant vis-à-vis, the anterior chamber was important for steroid therapy. Data were mixed on the relationship between IOP increase and the type of intravitreal injection, number of intravitreal injections, preexisting glaucoma, and globe decompression before injection. There were no data on the onset or progression of glaucoma in the studies reviewed in this assessment. However, some studies demonstrated RNFL thinning in patients receiving chronic anti-VEGF therapy. Most, if not all, intravitreal agents cause ocular hypertension, both in the short term and long term. The functional consequences of these observations are not very clear.
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http://dx.doi.org/10.4103/ijo.IJO_1028_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7933876PMC
February 2021

Real-World Efficacy and Safety of Fluocinolone Acetonide Implant for Diabetic Macular Edema: A Systematic Review.

Pharmaceutics 2021 Jan 7;13(1). Epub 2021 Jan 7.

Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon 1, 69004 Lyon, France.

To assess real-world outcomes of fluocinolone acetonide (FAc) implant in treating diabetic macular edema (DME), a systematic literature review was conducted on PubMed in order to identify publications assessing the efficacy and safety of the FAc implant in DME in daily practice. Case reports and randomized controlled trials were excluded. Twenty-two observational real-world studies analyzing a total of 1880 eyes were included. Mean peak visual gain was +8.7 letters (11.3 months post-FAc injection) and was greater for lower baseline best corrected visual acuity (BCVA) and for more recent DME. Mean central retinal thickness (CRT) decreased 34.3% from baseline. 77.0% of the analyzed studies reported both BCVA improvement of at least five letters and a CRT decrease by 20% or more. Rescue therapy was needed more frequently when FAc was administered for chronic DME. FAc-induced ocular hypertension was reported in 20.1% of patients but only 0.6% needed surgery. Cataract extraction was performed in 43.2% of phakic patients. Adequate patient selection is essential for optimal FAc response and better safety profile. Currently positioned as second- or third-line treatment in the management algorithm, FAc implant decreases treatment burden and provides better letter gain when administered for more recent DME.
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http://dx.doi.org/10.3390/pharmaceutics13010072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827527PMC
January 2021

Single Injection Response to Anti-Vascular Endothelial Growth Factor Agents in Patients with wet Age related Macular Degeneration: Incidence and Characteristics.

Retina 2021 Jan 4. Epub 2021 Jan 4.

Alphavision Augenzentrum, Bremerhaven, Germany Service d'Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Université Lyon 1, Lyon, France Laboratoire UMR-CNRS 5510 Matéis, Université Lyon 1, Villeurbane, France Sudhalkar Eye Hospital and Retina Centre, Baroda, India Raghudeep Eye Hospital, Ahmedabad, India.

Purpose: To determine the incidence of complete resolution of choroidal neovascular membrane(CNV) associated exudation with a single anti-vascular endothelial growth factor(anti-VEGF) injection in treatment naïve wet age related macular degeneration(AMD) patients and its associated characteristics.

Methods: Retrospective, observational study of naïve wet AMD patients who received anti-VEGF therapy with ranibizumab/aflibercept and demonstrated complete resolution of retinal exudation with a single injection. Complete resolution was defined as total disappearance of the intraretinal fluid, cysts and subretinal fluid and a return of retinal thickness to <250 microns on spectral domain optical coherence tomography(SDOCT). All relevant data was collected. Follow up was scheduled on days 1, 7 and 30 postoperatively and then monthly, with at least 9 visits mandatory per year if the macula remained fluid free. Appropriate statistical analyses were performed.

Results: 63 patients(29 males; mean age 67.25±4.40 years) were identified. The mean baseline and final corrected distance visual acuity(CDVA) was 20/160 and 20/45 respectively. Patients completed a mean of 10.9 follow-up visits per year. Smaller CNVs(<200 microns), early presentation, better presenting CDVA, sub-foveal CNVs, absence of blood/fibrosis and use of aflibercept(2mg) favoured resolution with one injection.

Conclusion: A subset(13.76%; 63/458,95% confidence intervals: 10.73-17.25) of patients with treatment naïve wet AMD demonstrates resolution of CNV associated exudation with a single anti-VEGF injection, sustained over 2 years or more. This can lower therapy costs, treatments, office visits and the potential risk of geographic atrophy.
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http://dx.doi.org/10.1097/IAE.0000000000003106DOI Listing
January 2021

Quantitative analysis of choriocapillaris alterations in swept source OCT angiography in diabetic patients.

Retina 2021 Jan 2. Epub 2021 Jan 2.

Service d'Ophtalmologie, Hôpital universitaire de la Croix-Rousse, Hospices Civils de Lyon, France Laboratoire UMR-CNRS 5510 Matéis, Villeurbane, France Groupe Hospitalier Public Sud de l'Oise, Creil, France Institut des Sciences et Techniques de la Réadaptation - Orthoptie, Lyon, France Centre de Recherche Clinique, Hôpital universitaire de la Croix-Rousse, Hospices Civils de Lyon, France.

Purpose: To evaluate quantitative alterations of the choriocapillaris in swept source (SS) OCT-Angiography (OCT-A) in diabetic patients.

Methods: We included normal patients and diabetic patients with and without diabetic retinopathy (DR), excluding patients with macular edema. Angiograms in 3x3mm were acquired with Plexelite 9000 SS OCT-A. Choroidal flow voids were analyzed after removal of projection artefacts. The main evaluation was the correlation between choroidal flow voids area (FVA-CC) and DR stage.

Results: A total of 120 eyes of 72 patients were analyzed. There were 17 eyes from healthy subjects, 30 eyes without DR, 22 eyes with minimal non-proliferative DR (NPDR), 30 eyes with moderate NPDR, 16 eyes with severe NPDR, and 5 eyes with proliferative DR (PDR). The percentage of FVA-CC for each group was respectively: 10.9 +/- 3.4 %; 14.6+/- 4.8 %; 17.6 +/- 3.5 %; 20.7 +/- 5.9 %; 19.9 +/- 2.9 %; and 26.6 +/- 4.4 %. FVA-CC and DR stage were significantly correlated (p<0.0001). FVA-CC was significantly increased in diabetic patients without DR compared to healthy subjects (p =0.008).

Conclusion: Diabetes is associated with quantifiable choriocapillaris alterations in SS OCT-A. These alterations precede clinical signs of DR and are correlated to DR stage.
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http://dx.doi.org/10.1097/IAE.0000000000003102DOI Listing
January 2021

Light-induced modifications of the outer retinal hyperreflective layers on spectral-domain optical coherence tomography in humans: an experimental study.

Acta Ophthalmol 2021 Jan 4. Epub 2021 Jan 4.

Department of Ophthalmology, Rothschild Foundation, Paris, France.

Purpose: Numerous small hyperreflective dots (HRDs) can be seen within the hyporeflective layer between the ellipsoid zone (EZ) and the interdigitation zone (IZ) on C-scan spectral-domain optical coherence tomography (SD-OCT) with a yet unknown variation under light conditions. The aim of this study was to explore light-induced SD-OCT changes in these HRDs.

Methods: The study subjects were randomly assigned to two groups: Group 1 experienced a dark adaptation protocol followed by intense retinal photobleaching, while Group 2, serving as the control group, was exposed to constant ambient light without any variation. The number of HRDs was automatically counted.

Results: Twenty healthy volunteers were prospectively included. The number of HRDs differed significantly over time (p = 0.0013). They decreased in Group 1 after dark adaptation and retinal photobleaching before returning to baseline levels 30 min later; conversely, they remained relatively constant in Group 2 throughout the study (p < 0.001). Light-skinned subjects had less HRD than dark-skinned subjects.

Conclusion: We observed light-induced modifications in the space between the EZ and the IZ. We hypothesize that the HRDs visible in this zone correspond to melanosomes that are mobilized during the light stimulation protocol. Larger studies are recommended to further evaluate and confirm light-induced SD-OCT changes under physiological and pathological conditions.
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http://dx.doi.org/10.1111/aos.14723DOI Listing
January 2021

Unexpected amaurosis occurring after peribulbar anesthesia: Exploring the causes in two cases.

Eur J Ophthalmol 2020 Dec 24:1120672120984399. Epub 2020 Dec 24.

Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon 1, Lyon, France.

Peribulbar anesthesia (PB) is known to be safer than retrobulbar (RB) anesthesia. To our knowledge, no amaurosis has been described after PB. We report here the cases of two patients who underwent PB before membrane peeling. The injections were administered with a 25-gauge, 22-mm bevel disposable needle. The anesthetic used was ropivacaine 1% with a volume of 8 ml and 75 µg of clonidine as an adjuvant (7.5 µg/ml). Given that complete akinesia was not achieved, a second injection of 2 ml was administered in the supero-medial injection site. Thirty minutes after the PB, the first patient experienced amaurosis with no light perception (LP). The ophthalmic examination was normal. Visual acuity recovered after 1 day. Regarding the second patient, the loss of VA was observed 20 min after the PB. IOP was 20 mmHg. The anterior segment and fundus exam were normal. Rubin found the PB technique to be as effective and safer than RB injection, as the needles are not supposed to enter the RB space and Davis and Mandel found no amaurosis after PB. PB is administered via the extraconal injection of an anesthetic agent. These amaurosis might be explained by the fact that some anesthetic may have penetrated the RB space. In cases where two PB injections are administered, the anatomy is expected to change due to the volume effect of the first injection. The second injection is higher risk as it is administered closer to the optic nerve.
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http://dx.doi.org/10.1177/1120672120984399DOI Listing
December 2020

LONG-TERM INCIDENCE AND RISK FACTORS OF OCULAR HYPERTENSION FOLLOWING DEXAMETHASONE-IMPLANT INJECTIONS: THE SAFODEX-2 STUDY.

Retina 2021 Jul;41(7):1438-1445

Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France.

Purpose: To analyze the incidence, risk factors, and time to onset of ocular hypertension (OHT) after intravitreal injections (IVI) of dexamethasone implant and to evaluate the long-term cumulative probability of intraocular pressure elevation.

Methods: Eyes of patients having received at least one dexamethasone implant IVI between October 2010 and February 2015 were included in the present study. Ocular hypertension was defined as intraocular pressure > 25 mmHg and/or an increase of 10 mmHg over the follow-up period compared with baseline intraocular pressure.

Results: Four hundred ninety-four eyes were studied in 410 patients. For a total of 1,371 IVI, the incidence of OHT was 32.6% in the study eyes with a mean follow-up period of 30 months (3-62.5) and a median follow-up of 29 months. Pressure-lowering treatment was introduced for 36.9% of eyes. Topical treatment alone was sufficient to manage OHT in 97%. Young age, male sex, uveitis and retinal vein occlusion, and glaucoma treated with a double- or triple-combination topical pressure-lowering medication were found to be risk factors for OHT. The incidence of OHT did not change with an increase in the number of IVI, and there was no cumulative effect, defining by an increase of the incidence of OHT in patients after repeated IVI (P = 0.248).

Conclusion: This study confirmed that OHT is of moderate incidence, transient, controlled by topical treatment and provides data on the long-term cumulative probability of intraocular pressure elevation in a large cohort of eyes treated with dexamethasone implant IVI. Repeat injections of dexamethasone implant neither increase nor decrease the risk of OHT.
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http://dx.doi.org/10.1097/IAE.0000000000003080DOI Listing
July 2021

Trends in Real-World Neovascular AMD Treatment Outcomes in the UK.

Clin Ophthalmol 2020 14;14:3331-3342. Epub 2020 Oct 14.

Service d'ophtalmologie, Hospices Civils de Lyon, Groupement Hospitalier Nord, Hôpital de la Croix-Rousse, Lyon, France.

Purpose: To report trends in real-world outcomes of anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (nAMD) in the United Kingdom (UK) over the last decade.

Design: Systematic review.

Methods: Medline, PubMed, and Embase databases were searched from 9 April 2010 to 8 April 2020 for publications that met the inclusion criteria: treatment-naïve eyes, UK-only data and ≥1 year of follow-up. ICHOM (International Consortium for Health Outcome Measures) outcomes and study quality were assessed. Visual acuity (VA) trends were assessed in studies with ≥100 eyes at baseline.

Results: Twenty-six studies (n=25,761 eyes) were included, meeting 14-17 out of 20 Institute of Health Economics Quality Appraisal of Case Series checklist domains. Only ranibizumab and aflibercept outcome data were available. The mean injection number in the first year of treatment was 5.9 in publications from 2010 to 2015 and 7.1 from 2015 to 2020. Average baseline VA and mean one-year, two-year and three-year VA gains gradually improved over the last decade. Longer-term studies reported that the visual gains achieved in the first year of treatment were rarely maintained, with under-treatment a likely contributing factor.

Conclusion: UK real-world outcomes have improved over the last decade with improved service delivery and the adoption of more proactive treatment regimens but are still not always as impressive as registration clinical trial results. Access to longer-acting anti-VEGF therapies would reduce the treatment burden for patients, carers, and the healthcare system, potentially making replication of clinical trial results possible in the NHS.
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http://dx.doi.org/10.2147/OPTH.S275977DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7569079PMC
October 2020

The 10q26 Risk Haplotype of Age-Related Macular Degeneration Aggravates Subretinal Inflammation by Impairing Monocyte Elimination.

Immunity 2020 08;53(2):429-441.e8

Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012 Paris, France. Electronic address:

A minor haplotype of the 10q26 locus conveys the strongest genetic risk for age-related macular degeneration (AMD). Here, we examined the mechanisms underlying this susceptibility. We found that monocytes from homozygous carriers of the 10q26 AMD-risk haplotype expressed high amounts of the serine peptidase HTRA1, and HTRA1 located to mononuclear phagocytes (MPs) in eyes of non-carriers with AMD. HTRA1 induced the persistence of monocytes in the subretinal space and exacerbated pathogenic inflammation by hydrolyzing thrombospondin 1 (TSP1), which separated the two CD47-binding sites within TSP1 that are necessary for efficient CD47 activation. This HTRA1-induced inhibition of CD47 signaling induced the expression of pro-inflammatory osteopontin (OPN). OPN expression increased in early monocyte-derived macrophages in 10q26 risk carriers. In models of subretinal inflammation and AMD, OPN deletion or pharmacological inhibition reversed HTRA1-induced pathogenic MP persistence. Our findings argue for the therapeutic potential of CD47 agonists and OPN inhibitors for the treatment of AMD.
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http://dx.doi.org/10.1016/j.immuni.2020.07.021DOI Listing
August 2020

Long-term follow-up of diabetic macular edema treated with dexamethasone implant: a real-life study.

Acta Diabetol 2020 Dec 12;57(12):1413-1421. Epub 2020 Jul 12.

Service D'Ophtalmologie, Hôpital Universitaire de La Croix-Rousse, Hospices Civils de Lyon, Université Lyon 1, 103, Grande Rue de la Croix-Rousse, 69317, Lyon Cedex 04, France.

Aims: To evaluate the efficacy and safety of intravitreal dexamethasone implant (DEX-implant) for diabetic macular edema (DME) in real-life practice with an extended follow-up for up to 5 year.

Methods: This multicentric retrospective study reviewed 227 eyes of 152 patients with DME treated by DEX-implant. Main outcome measures included changes in best corrected visual acuity (BCVA), central macular thickness (CMT), time to retreatment and incidence of adverse effects.

Results: The mean number of DEX-implant received by patients was 2.6 (± 2.2) with a mean (SD) follow-up of 20.1 (± 15.8) months, median [IQR] 15.8 [7.4-30.1]. The mean time of retreatment was 6.9 months. The mean maximal BCVA gain during follow-up was 12.3 (± 12.7) letters. A gain of ≥ 5, ≥ 10 and ≥ 15 letters from baseline BCVA was obtained for 71.8%, 48.9% and 34.8% of eyes, respectively. A total of 62.6% of eyes presented a significant anatomical response (decrease of CMT ≥ 20%), and DME was resolved (absence of cystoid macular spaces on OCT) in 37% of cases at the end of the follow-up. A transient increase in intraocular pressure ≥ 25 mmHg occurred in 14.1% of eyes, and cataract surgery was performed for 49.1% of the phakic eyes during the follow-up. Four eyes developed a proliferative diabetic retinopathy.

Conclusion: This large cohort study showed favorable long-term outcomes when using DEX-implant, which provides substantial long-term benefits in the treatment of DME in real life.
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http://dx.doi.org/10.1007/s00592-020-01561-1DOI Listing
December 2020

UVEITIS TREATED WITH DEXAMETHASONE IMPLANT.

Retina 2021 Mar;41(3):620-629

Service d'Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Université Lyon 1, Lyon, France.

Purpose: To evaluate the real-life efficacy and safety of the intravitreal dexamethasone implant in uveitis.

Methods: This retrospective observational multicentric study included 152 eyes treated exclusively by 358 dexamethasone implant injections. The main outcome measures included change in the best-corrected visual acuity, central macular thickness, and vitreous haze score.

Results: Patients were treated with dexamethasone implant for macular edema (51.3%), vitritis with macular edema (40.1%), vitritis (5.3%), and other causes (3.3%). The mean duration of follow-up was 19.0 months. The mean gain in best-corrected visual acuity during follow-up was +12.1 letters. An improvement in best-corrected visual acuity ≥5, 10, and 15 letters was found in 64.5, 50.7, and 35.5% of cases, respectively. 59.7% of eyes with macular edema at baseline were found to be anatomical responders. Vitritis resolution (vitreous haze = 0+) was obtained in 81.4% of cases. Ocular hypertension (intraocular pressure ≥25 mmHg and/or gain ≥10 mmHg from baseline) occurred in 28.3% of patients. No filtering surgery/laser therapy was required. A total of 40.2% of phakic subjects underwent cataract surgery on average 11.2 months after the first injection.

Conclusion: This study confirms the efficacy and safety of the dexamethasone implant in noninfectious uveitis. Cataract and ocular hypertension were not uncommon but easily manageable.
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http://dx.doi.org/10.1097/IAE.0000000000002901DOI Listing
March 2021

Current role of intravitreal injections in Irvine Gass syndrome-CRIIG study.

Int Ophthalmol 2020 Nov 1;40(11):3067-3075. Epub 2020 Jul 1.

Department of Ophthalmology, Croix-Rousse Hospices Civils de Lyon, University of Lyon, Lyon, France.

Objective: To analyze the role of intravitreal anti-vascular endothelial growth factor (anti-VEGF) or steroid injection for the management of Irvine Gass syndrome.

Methods: It is an interventional, retrospective, multicenter study. One hundred and thirty-two injections were given in 79 eyes of 72 patients with Irvine Gass syndrome. Patients were treated with at least one intravitreal injection of either anti-VEGF or steroid. Outcomes were measured at 12 months (± 1 week). [Ranibizumab (Lucentis; Genentech, South San Francisco, CA) (Razumab; Intas Pharmaceutical Ltd, Ahmedabad, India) Bevacizumab (Avastin; Genentech, South San Francisco, CA) or Aflibercept (Eylea; Regeneron, Tarrytown, NY)] or steroids [Dexamethasone implant (Ozurdex, Allergan Inc, Irvine, CA) or intravitreal triamcinolone)].

Results: Intravitreal injections were initiated in (67.6%) of eyes within 14 weeks of diagnosis. Intravitreal dexamethasone implant was used as the initial intravitreal therapy in (73.4%) of eyes. More than fifty percent (54.5%) of the patients were switched from anti-VEGF to Intravitreal dexamethasone implant. Reduction in the mean CMT was 336.7 ± 191.7 and 160.1 ± 153.1 microns in eyes treated within four weeks and more than 14 weeks from diagnosis (p = 0.005). Mean ETDRS letter gain was 16.7 ± 12.9 and 5.2 ± 9.2 in eyes treated within 4 weeks and more than 14 weeks from diagnosis (p = 0.004). Three eyes injected with intravitreal dexamethasone implant reported an intraocular pressure spike of > 25 mmHg which was controlled with topical medications. No other ocular or systemic adverse events were observed.

Conclusion: Study results suggest that physicians tend to introduce intravitreal therapy within 14 weeks of diagnosis. The most common therapy at initiation and for the switch is intravitreal dexamethasone implant. Patients treated early (within 4 weeks) respond better in terms of structure and function.
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http://dx.doi.org/10.1007/s10792-020-01491-5DOI Listing
November 2020

Variation of choroidal thickness in diabetic macular edema: friend or foe?

Acta Ophthalmol 2021 Mar 26;99(2):e282-e283. Epub 2020 Jun 26.

Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Medicine Lyon 1, Lyon, France.

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http://dx.doi.org/10.1111/aos.14530DOI Listing
March 2021

Contribution of swept-source OCT-angiography in analysis of choroidal osteoma and its quiescent neovascular complications: A case study.

Am J Ophthalmol Case Rep 2020 09 6;19:100769. Epub 2020 Jun 6.

Ophthalmology Department, Croix-Rousse Teaching Hospital, Lyon, France.

Purpose: Choroidal osteoma (CO) is a rare benign tumor of the choroid. Improvements in Optical Coherence Tomography (OCT) technologies, notably swept-source (SS), enables a better visualization of the choroid with deeper signal penetration in the tissues.

Observation: We describe SS-OCT and OCT-angiography findings in a 30-year-old patient with CO. The best visualization of the choroid allows even more precise analysis beyond the identification of classical structures of trabecular bone and denser cortical bone. OCT-Angiography show in this case a quiescent choroidal neovascularization without exudation on B-scan OCT.

Conclusions And Importance: SS-OCT and OCT-angiography allow a nearly histological description of choroidal osteoma.

Patient Consent: Written consent to publish this case has not been obtained. This report does not contain any personal identifying information.
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http://dx.doi.org/10.1016/j.ajoc.2020.100769DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7287234PMC
September 2020

COMPARATIVE EFFECTIVENESS OF PROTON BEAM VERSUS PHOTODYNAMIC THERAPY TO SPARE THE VISION IN CIRCUMSCRIBED CHOROIDAL HEMANGIOMA.

Retina 2021 Feb;41(2):277-286

Service de Radiothérapie, Centre François Baclesse/ARCHADE-Normandie Université, Caen, France; and.

Purpose: The aim of this study was to compare the functional and anatomical effectiveness of photodynamic therapy (PDT) versus proton beam therapy (PBT) in a real-life setting for the treatment of circumscribed choroidal hemangioma.

Methods: A total of 191 patients with a diagnosis of circumscribed choroidal hemangioma and treated by PBT or PDT were included for analyses.

Results: The 119 patients (62.3%) treated by PDT were compared with the 72 patients treated by PBT. The final best-corrected visual acuity did not differ significantly between the two groups (P = 0.932) and final thickness was lower in the PBT compared with the PDT group (P = 0.001). None of the patients treated by PBT needed second-line therapy. In comparison, 53 patients (44.5%) initially treated by PDT required at least one other therapy and were associated with worse final best-corrected visual acuity (P = 0.037). In multivariate analysis, only an initial thickness greater than 3 mm remained significant (P = 0.01) to predict PDT failure with an estimated odds ratio of 2.72, 95% confidence interval (1.25-5.89).

Conclusion: Photodynamic therapy and PBT provide similar anatomical and functional outcomes for circumscribed choroidal hemangioma ≤3 mm, although multiple sessions are sometimes required for PDT. For tumors >3 mm, PBT seems preferable because it can treat the tumor in only 1 session with better functional and anatomical outcomes.
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http://dx.doi.org/10.1097/IAE.0000000000002843DOI Listing
February 2021

Increased choroidal thickness: a new indicator for monitoring diabetic macular oedema recurrence.

Acta Ophthalmol 2020 Dec 17;98(8):e968-e974. Epub 2020 Apr 17.

Service d'ophtalmologie, Hôpital de la Croix Rousse, Lyon, France.

Purpose: The aim of this study was to determine whether choroidal thickness (CT) increases at the time of exudative recurrence in diabetic patients with unilateral diabetic macular oedema (DME) treated with intravitreal injections of anti-VEGF or dexamethasone.

Methods: A real-life, prospective, two-centre study was conducted over a 9-month period investigating diabetic patients presenting with unilateral DME treated with anti-VEGF or dexamethasone intravitreal injections, and CT was measured manually, using the enhanced depth imaging module of the spectral domain optical coherence tomography. Choroidal thickness (CT) was measured in the morning, in both the affected and healthy eye of each patient at two timepoints: when the macula was 'dry' (T0) and at the time of exudative recurrence (T1).

Results: A total of 51 patients with unilateral DME were included. Mean CT in the affected eye was significantly thicker at the time of exudative recurrence (210.8 ± 44.1 μm at T0 versus 238.0 ± 49.0 μm at T1, p < 0.001). There was no significant variation in CT in the fellow eye (214.4 ± 52.3 µm at T0 versus 218.9 ± 53.4 µm at T1, p = 0.53). The type of intravitreal injection, the number of injections and the CT at T0 had no influence on the change in CT.

Conclusion: This study found that CT increased significantly in the affected eye at the time of recurrence of DME treated with anti-VEGF or dexamethasone injections. Choroidal thickness (CT) could constitute an interesting new indicator for monitoring patients with DME.
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http://dx.doi.org/10.1111/aos.14447DOI Listing
December 2020

Complications of cosmetic iris implants: French series of 87 eyes.

J Cataract Refract Surg 2020 01;46(1):34-39

Military Hospital of Desgenettes, Lyon, France (El Chehab and Dot); Rothschild Foundation, Paris, France (Gatinel); Quinze-Vingts National Ophthalmology Hospital, Paris, France (Baudouin); Charles-Nicolle Hospital, CHU de Rouen, Rouen, France (Muraine); Clinique Monticelli-Vélodrome, Marseille, France (Hoffart); Clinique Juge, Marseille, France (Rozot and Baïkoff); Hôtel-Dieu-Cochin Hospital, Paris, France (Mehanna and Bonnet); Clinique Sourdille, Nantes, France (Santiago); Édouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France (Burillon); Pasteur Hospital, Nice, France (Baillif); Bretonneau Hospital, Tours, France (Pisella); Nantes University Hospital, Nantes, France (Weber); Pellegrin Hospital, Bordeaux France (Robinet-Perrin); Private center, Toulon, France (Deidier); Private center, Nancy, France (Hay); Gui de Chauliac Hospital, Montpellier, France (Villain); Besancon University Hospital, Besancon, France (Gauthier); Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France (Mathis); and French Military Health Service Academy of Val de Grâce, Paris, France (Dot).

Purpose: Iris intraocular implants were developed to manage congenital or traumatic iris defects. However, they are also used to change the color of patient eyes. The aim of this retrospective series was to report complications in patients managed in France after cosmetic implantation.

Setting: Ophthalmological institutions and private ophthalmologists in France.

Design: Multicenter retrospective observational study.

Methods: Questionnaires were sent to all ophthalmology departments in university hospitals and to private ophthalmologists. This questionnaire listed demographic and clinical data for each implanted eye with a focus on safety, the description of ocular complications (corneal edema, endothelial cell loss, increased intraocular pressure, and intraocular inflammation), and the therapeutic management implemented.

Results: Forty-four questionnaires (87 eyes) were collected, and ultimately, 33 questionnaires (65 eyes) were considered complete and analyzed. Two types of implants were identified. Of the 65 eyes analyzed, only 5 eyes (7.7%) did not experience any complication and 60 eyes (92.3%) had at least 1 complication. The most commonly reported complication was corneal decompensation (78.5%). The diagnosis of glaucoma was made in over half (52.3%) of the cases. Explantation was needed in 81.5% of cases. The mean final visual acuity was 0.45 ± 0.08 logarithm of the minimum angle of resolution (logMAR) (0 to 2 logMAR).

Conclusions: Several ocular complications with a decreased mean visual acuity were described in a young healthy population. In addition, patient information on the safety of this procedure appeared insufficient.
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http://dx.doi.org/10.1097/j.jcrs.0000000000000032DOI Listing
January 2020

HYPERAUTOFLUORESCENT SPOTS IN ACUTE OCULAR TOXOPLASMOSIS: A New Indicator of Outer Retinal Inflammation.

Retina 2020 Dec;40(12):2396-2402

Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France.

Purpose: The aim of this study was to describe the fundus autofluorescence patterns in acute ocular toxoplasmosis (OT) and to correlate these findings with other imaging.

Methods: A retrospective multicenter case series of 27 eyes from 27 patients with acute onset of posterior OT was conducted. Multimodal imaging including fundus autofluorescence was performed at diagnosis and during follow-up.

Results: All OT lesions were hypoautofluorescent on fundus autofluorescence imaging. Fourteen patients (51.8%) also had hyperautofluorescent spots around the active foci that disappeared after retinal photobleaching. Although these spots were not seen on early phase of indocyanine green angiography, they become hypofluorescent in the late phase without choriocapillaris flow impairment on optical coherence tomography angiography. On B-scan spectral domain optical coherence tomography, spots corresponded to outer retinal alterations in all cases. All hyperautofluorescent spots disappeared during follow-up as acute OT resolved. Younger patients and those with more posterior inflammatory symptoms (vasculitis and/or papillitis) were more frequent with the presence of hyperautofluorescent spots.

Conclusion: Ocular toxoplasmosis may trigger a transient outer retinal disruption in eyes with marked inflammatory symptoms of the younger patients.
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http://dx.doi.org/10.1097/IAE.0000000000002759DOI Listing
December 2020

Choroidal Metastasis From Melanoma Treated by Cyberknife Irradiation.

JAMA Ophthalmol 2020 01 9;138(1):e190388. Epub 2020 Jan 9.

Department of Radiation Therapy, Centre François Baclesse-ARCHADE, Unicaen-Normandie University, Caen, France.

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http://dx.doi.org/10.1001/jamaophthalmol.2019.0388DOI Listing
January 2020

Radiation induced optic neuropathy: Does treatment modality influence the risk?

Bull Cancer 2019 Dec 19;106(12):1160-1176. Epub 2019 Nov 19.

Centre François-Baclesse/ARCHADE, Department of Radiation Oncology, 3, avenue General Harris, 14000 Caen, France; Unicaen - Normandie Université, laboratoire de physique corpusculaire IN2P3/ENSICAEN - UMR6534, boulevard du Marechal Juin, 14050 Caen, France.

Radiation induced optic neuropathy (RION) is a rare but disastrous complication of radiation therapy in treatment of periorbital tumors. The objective of this study is to investigate the incidence of RION in series of patients treated from peri orbital tumors by recent photon and proton irradiation modalities. We searched the Pub Med database for studies in periorbital tumors including base of skull, sinonasal, pituitary, nasopharyngeal tumors and craniopharyngioma treated with Intensity modulated radiotherapy (IMRT) and with proton beam therapy (PBT) between 1992 and 2017 excluding metastatic tumors, lymphomas, pediatric series, those treated mainly with chemotherapy, target therapy and those written in languages other than English and French. The result retrieved 421 articles that were revised by the panel. Fourteen articles with IMRT and 27 with PBT reported usable data for the review from which 31studies that had pointed to the doses to the optic nerve (ON) and/or optic chiasm (OC) and incidence of RION have been analyzed. We have found that the incidence of RION had been reported fairly in both modalities and many other factors related to the patient, tumor, and irradiation process interplay in its development. We have concluded that proper treatment planning, good selection of treatment modality, adherence to dose constraints applied to critical structures all along with regular oncological and ophthalmological follow up, control of co-morbidities and early intervention, could help reducing its magnitude.
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http://dx.doi.org/10.1016/j.bulcan.2019.09.008DOI Listing
December 2019
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