Macular Degeneration: Soubrane G

Souied E, Le Tien V, Coscas G, Soubrane G. · No affiliation provided · J Fr Ophtalmol. · Pubmed #17568337 links to  free full text

This publication has no abstract.

Soubrane G. · No affiliation provided · J Fr Ophtalmol. · Pubmed #11033493 links to  free full text

This publication has no abstract.

Parier V, Soubrane G. · Département universitaire d'ophtalmologie, centre hospitalier intercommunal de Créteil-universitaire Paris-12, 94010 Créteil, France. · Rev Med Interne. · Pubmed #18262310 No free full text.

Abstract: PURPOSE: Age-related macular degeneration is the commonest overall cause of irreversible blindness in patients aged 50 or over in the Western world. CURRENT KNOWLEDGE AND KEY POINTS: Because of the interaction of genetic and environmental origin, the pathogenesis of this affection remains imperfectly elucidated. The disease has been traditionally classified into early and late stages with its dry and wet forms. In association with fluorescein angiography, essential for diagnosis, green indocyanin angiography and optical coherence tomography made it possible to better know the clinical forms of the disease. Patients with age-related maculopathy should consider taking a dietary supplement such as that used in the age-related eye disease study. Exudative age-related macular degeneration is approached depending on the type and localisation of the choroidal new vessels. Laser photocoagulation has only been shown to be beneficial for extra and juxtafoveal classic lesions. Photodynamic therapy with verteporfin is effective in the management of eyes with subfoveal predominantly classic lesions. The encouraging results of new therapeutic with antiangiogenic aiming against vascular endothelial growth factor are a hope to preserve the sight of our patients. FUTURE PROSPECTS AND PROJECTS: In the future, many therapeutics inhibiting neo-vessels will widen our therapeutic options in the treatment of exsudative age-related macular degeneration.

Benyelles N, Soubrane G. · Centre ophtalmologique universitaire de Créteil, centre hospitalier intercommunal. · Rev Prat. · Pubmed #16903520 No free full text.

Abstract: Age-related macular degeneration (AMD) is the commonest overall cause of irreversible blindness in patients aged 50 or over in the western world. It is a spectrum of related diseases that have in common the progressive decline of vision as a consequence of dysfunction of the central retina and its underlying supporting elements, principally the retinal pigment epithelium and choroid in older adults. The disease has been traditionally classified into early and late stages with its dry and wet forms. Patients with age-related maculopathy should consider taking a dietary supplement such as that used in AREDS. There is no effective treatment for geographic atrophy. The exudative AMD is approached depending on the type and localisation of choroidal new vessels. Laser photocoagulation has only been shown to be beneficial for extra and juxtafoveal well defined lesions. PDT with verteporfin is effective in the management of patients with subfoveal predominantly classic lesions. A variety of molecules such as bevacizumab, pegaptanib sodium and ranibizumab, specifically targeted to different pathologic pathways in AMD, have been identified to their therapeutic potential. Research is actively being pursued in preclinical models both in academic laboratories and in the pharmaceutical industry, including multiple early stage clinical trials. There is no strong evidence to support benefits of submacular surgery in the management of neovascular AMD.

Soubrane G, Souied E, Haddad W, Razavi S, Roquet W, Coscas G. · Clinique Ophtalmologique Universitaire de Créteil, Université Paris-XII, 40, avenue de Verdun, 94010 Créteil. · J Fr Ophtalmol. · Pubmed #14586234 links to  free full text

Abstract: Classic neovessels (CNVs) identified on fluorescein angiography may benefit from thermal laser photocoagulation when sparing the fovea. If they extend into it, photodynamic therapy may halt the natural progression to a central scotoma. Occult CNVs, when subfoveal, may benefit from photodynamic therapy when isolated (not associated with classic CNV or with a pigment epithelium detachment). A number of therapeutic approaches are being evaluated in order to diversify the therapeutic choices available for treatment of CNVs. Transpupillary thermotherapy, which causes a limited increase in retinal temperature, could produce a sclerosis of occult isolated CNV. This approach has shown interesting results in pilot studies but also carries a risk for iatrogenic effects. The American randomized clinical trial currently under way will provide an evaluation of this treatment. An antiangiogenic therapy currently in progress is studying anecortave acetate and another is investigating anti-VEGF compounds. Anecortave acetate, which demonstrated its angiostatic activity in experimental models as well as in a phase II study, is now in a worldwide randomized clinical trial. The anti-VEGF molecules (antibodies and oligonucleotides) have shown very interesting preliminary results and are being evaluated in a large number of patients. Finally, a preventive therapy consisting of oral supplementation with antioxidants (vitamins C, E, and A) and zinc is a major step forward, providing the possibility of a real and effective prevention of the complications of age-related maculopathy.

Souied E, Kaplan J, Coscas G, Soubrane G. · Service d'Ophtalmologie, Hôpital Intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil. · J Fr Ophtalmol. · Pubmed #13130265 links to  free full text

Abstract: Macular dystrophies are a group of hereditary disorders of the macula occurring in children or young adults. The most frequent in France will be presented in detail: Best disease, Stargardt macular dystrophy, cone dystrophy, X-linked retinoschisis, pattern dystrophy, and malattia leventinese. Molecular biology studies have now mapped and identified the genes involved in these macular dystrophies. Analysis of the features of fundus examination will lead to further examinations such as fluorescein angiography, indocyanine green angiography, optical coherent tomography, electroretinography, or electrooculography, in order to confirm the diagnosis. We will also present the differential diagnosis of each of these macular dystrophies.

Haddad WM, Coscas G, Soubrane G. · Clinique Ophtalmologique Universitaire de Créteil, Université Paris XII, Créteil, France. · J Fr Ophtalmol. · Pubmed #12746610 links to  free full text

Abstract: Several studies suggest that apoptosis might play a major role in age-related macular degeneration. Apoptosis in retinal pigment epithelium cells undergoing severe oxidative stress has been reported and could therefore be involved in the pathogenesis of AMD. The processes of drusen formation seem to be similar to the processes described in apoptosis. Moreover, apoptosis appears to be involved in the early outgrowth of choroidal neovascular membranes as well as in the development of fibrotic scars at a later stage. Targeting apoptotic pathways should therefore be considered as a possible treatment approach for AMD.

Razavi S, Coscas G, Soubrane G. · Service Universitaire d'Ophtalmologie de Créteil, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94010 Créteil, France. · J Fr Ophtalmol. · Pubmed #12399735 links to  free full text

Abstract: In Western countries, age-related macular degeneration is the leading cause of visual loss in people aged 65 and over. Laser photocoagulation has been shown to be beneficial in patients with extra- or juxta-foveal classic choroidal neovascularization (CNV), but the majority of patients with exudative maculopathy have occult or subfoveal CNV. Laser photocoagulation is plagued by recurrences, which occur in more than 50% of cases. Because of the limited efficacy of laser photocoagulation and the small number of patients who are eligible for treatment, investigators are attempting to develop new modalities to treat CNV. These modalities can be classified into three major categories: surgery, photodynamic and pharmacological treatments.The general mechanism, the regulation of ocular angiogenesis, and current anti-angiogenic treatments are the subject of this review of the recent literature.

Soubrane G, Haddad WM, Coscas G. · Clinique ophtalmologique universitaire de Créteil, Université Paris XII, Créteil. · Presse Med. · Pubmed #12238278 No free full text.

Abstract: EPIDEMIOLOGICAL AND PATHOGENIC DATA: Age-related macular degeneration (ARMD) is the first cause of blindness in industrialized countries in patients over the age of 55. Its prevalence increases with age, affecting up to 25% of the population aged over 75. The pathogenesis of this disease is not well known. Not only aging, but also other varying degrees of genetic and environmental factors are implied. CLINICAL ASPECTS: Precursors (first clinical signs of ARMD) can be observed on examination of the fundus: drusen (localized deposits of lipids and lipoproteins) and alterations in retinal pigment epithelium (RPE) (hypo- or hyperpigmentation). Two forms of complications are observed: atrophic (or "dry") and exudative (or "wet"). The atrophic form is defined by the presence of degeneration in the central RPE, choriocapillaris and photoreceptors, resulting from the enlargement and/or coalescence of small areas of peri-foveolar atrophy (or "geographic" atrophy). The exudative form, responsible for the majority of cases of blindness due to ARMD, is characterized by the appearance of choroidal new vessels, identifiable on fluorescein angiography and responsible for serous retinal detachment, edema and hemorrhage, leading to the destruction of the macular photoreceptors. FROM A THERAPEUTIC POINT OF VIEW: Treatment of the atrophic form is currently only palliative (visual aids and re-habilitation of low vision). Treatments of the exudative form having demonstrated their efficacy are laser photocoagulation and dynamic phototherapy with verteporfine, providing relative stabilization of visual acuity in around 2/3 of the eyes. Other treatments are under evaluation: anti-angiogenic treatments, surgical techniques (ablation of the new vessels, foveal translocation), new laser treatments (transpupillary thermotherapy, selective photocoagulation of the feeder vessels). Photoreceptor and pigment epithelium transplantations or implantation of microphotodiodes represent other long-term alternatives.

Souied E, Kaplan J, Coscas G, Soubrane G. · Clinique Ophtalmologique Universitaire de Créteil, Université Paris XII, 40, avenue de Verdun, 94010 Créteil, France. · J Fr Ophtalmol. · Pubmed #11894541 links to  free full text

Abstract: Age related macular degeneration (AMD) is the main cause of blindness after age 55 in western countries. These last past years, several lines of evidence such as familial aggregation or twin studies suggested a genetic component in AMD. However, the late onset of the disease and the fact that AMD is a polygenic and multifactorial disease are the main limiting factors for linkage studies. Gene candidate strategy allowed the exclusion of several genes (VMD2, RDS, TIMP3) and lead to the implication of two genetic factors: the apoE gene (involved in the transport of lipids) and the ABCR gene (involved in Stargardt macular dystrophy). Concerning the apoE gene, a lower frequency of the epsilon 4 alleles carriers was observed in the exudative AMD population compared with controls, supporting the idea of a role of the apoE gene in exudative AMD with drusen. These results, together with ultrastructural studies, suggest that allele epsilon 4 is a protective factor for drusen and thus for AMD. For the ABCR gene, several studies and a large multicentric study definitively show that some heterozygous mutations are predisposing factors for AMD, in a polygenic and multifactorial model.

Soubrane G, Kuhn D, Oubraham H, Quaranta M, Coscas G. · Clinique Ophtalmologique Universitaire de Créteil, Université Paris-XII, 40, avenue de Verdun, 94010 Créteil. · J Soc Biol. · Pubmed #11723822 No free full text.

Abstract: Age-related macular degeneration has a natural progression from the precursors (the drusen) towards atrophic or neovascular complications. Choroidal neovascularization is undoubtedly the aspect of the disease that benefits most from new therapeutical approaches. Destructive photocoagulation based on fluorescein angiography has demonstrated since 20 years its efficiency on choroidal neovascularization. The same approach based on indocyanine green (ICG) angiography would increase the number of patients available to therapy. Very recently photodynamic therapy has demonstrated its efficiency to stabilize visual acuity at least at two years in patients with choroidal new vessels predominantly well defined. Other treatment developments are considered, such as refinement of photocoagulation techniques or of surgery. Until now, none has demonstrated its efficiency although they raise justified hopes. The future approaches rely upon the progress of the research both in physiopathology of the disease and on the angiogenic process requiring a constant interaction with all thematics of research. Finally, palliative treatments will be required before heading up to a preventive treatment.

Soubrane G. · Clinique Ophtalmologique Universitaire, 40, avenue de Verdun, 94010 Créteil, France. · J Fr Ophtalmol. · Pubmed #11351216 links to  free full text

Abstract: Photodynamic therapy (PDT) is a new approach for subfoveal choroidal new vessels (CNV) in age-related macular degeneration (ARM) and myopia, currently being evaluated in clinical trials. PDT is a two-step procedure: the intravenous perfusion of a photosensitizer is followed by light irradiation at the adapted wavelength. Verteporfin, the photosensitizer under investigation, has a maximum absorption at 692nm. Phase I and II studies determined the settings necessary to obtain optimal effects in humans with Verteporfin in the phase III study. It has been shown that this treatment is efficient and preserves initial visual acuity in 67% of Verteporfin-treated ARM eyes vs 39% of placebo-treated ARM eyes at 1 year. Fluorescein angiographic follow-up found a photo-occlusion of the CNV 14 days after treatment application followed by a partial reperfusion or reproliferation of the CNV at 3 months, resulting in the need for repeated treatments. Two-year results of the Phase III randomized clinical trial are awaited.

Soubrane G, Bressler NM. · Clinique Ophtalmologique Universitaire de Créteil, Université Paris-Val-de-Marne, Créteil, France. · Br J Ophthalmol. · Pubmed #11264143 links to  free full text

This publication has no abstract.

Rozet JM, Gerber S, Souied E, Ducroq D, Perrault I, Ghazi I, Soubrane G, Coscas G, Dufier JL, Munnich A, Kaplan J. · Unité de Recherches sur les Handicaps Génétiques de l'Enfant, INSERM U393, Hôpital des Enfants Malades, 149 rue de Sèvres, Paris Cedex 15, 75743, France. · Mol Genet Metab. · Pubmed #10527682 No free full text.

This publication has no abstract.

Glacet-Bernard A, Kuhn D, Soubrane G. · Clinique Ophtalmologique Universitaire de Créteil. · Contracept Fertil Sex. · Pubmed #10349771 No free full text.

Abstract: Numerous reports have described ocular complications of sex hormone preparations, particularly after the appearance of the oral contraceptive pill. The most serious complications are vascular occlusions such as central retinal vein or artery occlusion and acute ischemic optic neuropathy. In these cases, permanent visual loss may occur. Combined oral contraceptives have been reported to increase the incidence of these complications but it remains very low. It seems to lessen with the decrease in the estrogen dosage and the use of third-generation progestins. Conversely, post-menopausal hormone replacement therapy seems to have a protective effect for retinal vascular complications. Other ocular involvements have been described with sex hormone preparations but remain not yet confirmed, such as the effect on cataract, lacrymal secretion, diabetic retinopathy, age-related macular degeneration.

Querques G, Benlian P, Chanu B, Portal C, Coscas G, Soubrane G, Souied EH. · Department of Ophthalmology, University of Paris XII, Centre Hospitalier Intercommunal de Creteil, France. · Eur J Ophthalmol. · Pubmed #19123156 No free full text.

Abstract: PURPOSE: To create a pilot study in order to evaluate the feasibility of a prospective case-control study of oral supplementation with fish oil (docosahexaenoic acid [DHA]; eicosapentaenoic acid [EPA]) in a population with age-related macular degeneration (AMD). METHODS: A homogeneous group of 38 patients with drusenoid pigment epithelial detachment in one eye (PED) without choroidal new vessels (CNV) was selected. A complete ophthalmologic examination, and a complete profile of fatty acids in serum (S) and in red blood cell membranes (RBCM), were recorded at day 0 and month 6. In group 1, 22 patients were orally supplemented with EPA (720 mg/day) and DHA (480 mg/day) during 6 months. In group 2, 16 patients were followed as controls. Nutritional recommendations on fish consumption were given to both groups. RESULTS: In group 1, after 6 months supplementation we observed a significant blood enrichment in EPA (EPA-S: 2.20 vs 0.79, p<0.0001 and EPA-RBCM: 2.24 vs 0.85, p<0.0001) and in DHA (DHA-S: 2.47 vs 1.56, p<0.0001 and DHA-RBCM: 6.47 vs 4.67, p<0.0001). No change was observed in group 2 despite nutritional recommendations. In this short followup, no evolution to CNV was noted in either of the two groups. Neither side effects nor dropouts were observed in either of the groups. DISCUSSION: This study supports the feasibility of a long-term double-masked prospective case-control study in an AMD population in order to evaluate a potential benefit from oral supplementation with DHA.

Pawlak D, Glacet-Bernard A, Papp M, Roquet W, Coscas G, Soubrane G. · University Eye Clinic of Créteil, Intercommunal and Henri Mondor (Assistance Publique des Hôpitaux de Paris) Hospitals, University of Paris XII, 40 avenue de Verdun, 94010 Créteil, France. · Am J Ophthalmol. · Pubmed #15126153 No free full text.

Abstract: PURPOSE: To compare the visual outcome of macular translocation (MT) versus photodynamic therapy (PDT) for subfoveal predominantly classic neovascularization in age-related macular degeneration (AMD). DESIGN: Nonrandomized clinical trial. METHODS: Retrospective review of 65 consecutive patients with subfoveal neovascularization due to AMD. The follow-up was at least 6 months. Main outcome criteria were final best corrected visual acuity and the gain in visual acuity. RESULTS: A total of 29 eyes were treated with PDT with verteporfin, and 36 underwent MT with chorioscleral infolding. Both groups were similar for age, refraction, and lesion size. The initial visual acuity was lower in the MT group than in the PDT group (20/200 versus 20/100). Mean follow-up was 11 months for the PDT group and 14 months for the MT group. The mean displacement of the fovea after translocation was 1,274 microm (range, 250 to 1,900 microm). Mean number of retreatment by PDT was 2.5. At 1 year, both groups had the same final visual acuity (20/200), but the improvement was more favorable in the MT group (gain of 0.7 line in the MT group versus loss of 3.4 lines in the PDT group, P =.007). One eye in the PDT group (4.3%) had a gain of 3 lines or more versus eight eyes (38%) in the MT group; the lesion size was larger in the PDT group than in MT group (P =.036). CONCLUSION: In this retrospective study, MT seemed to allow a better preservation of visual acuity than PDT in subfoveal neovascularization due to AMD. Further larger and controlled studies are required.

Soubrane G, Kuhn D, Oubraham H, Coscas G. · Clinique Ophtalmologique Universitaire de Créteil, Université Paris-XII, 40 avenue de Verdun, 94010 Créteil. · J Fr Ophtalmol. · Pubmed #12399736 links to  free full text

Abstract: Photodynamic therapy with Verteporfine (Visudyne Novartis Ophthalmics) achieves a photo occlusion of subfoveal choroidal neovascularization (CNV) resulting from age-related macular degeneration (AMD) in phase 1 and 2 studies. Thereafter, two international randomized clinical trials evaluated the product's efficacy in term of visual acuity. Eyes with neovascular lesions due to AMD of less than 5,400 micro, in size involving the fovea and presenting well-defined CNV on fluorescein angiography could be included when visual acuity was between 5 and 1/10. Six hundred and nine patients were subsequently randomized either to Verteporfine or to placebo (proportion 2:1). A follow-up of 3 months made it possible to consider retreatment when a fluorescein leakage was observed. Functional and angiographic results demonstrated the efficacy of PDT with Verteporfine in comparison with placebo at each examination during follow-up. A visual acuity decrease of less than 15 letters on ETDRS (or 3 lines or approximately 1.5/10) occured less frequently in the treated group with PDT (61% out of 402 treated eyes compared with 46% of 207 placebo eyes). Subgroup analysis of predominantly well-defined CNV (involving 50% or more of the total of the exsudative lesion) showed even more favourable effects (67% of treated eyes versus 39% of placebo eyes). Conversely, when well-defined CNV extended to a smaller area, the results were not significant. The most frequent side effect was Verteporfine extravasation at the injection site. As dynamic phototherapy with Verteporfine limits the decrease in visual acuity always occurring in the natural history of CNV caused by AMD, it is desirable that patients presenting subfoveal predominantly well-defined lesions benefit from this new treatment approach.

Soubrane G. · Clinique Ophtalmologique Universitaire, Université de Paris XII, Créteil, France. · Doc Ophthalmol. · Pubmed #10896341 No free full text.

This publication has no abstract.

Glacet-Bernard A, Kuhn D, Coscas F, Coscas G, Soubrane G. · Clinique Ophtalmologique Universitaire de Créteil, 40, avenue de Verdun, 94000 Créteil. · J Fr Ophtalmol. · Pubmed #10880923 links to  free full text

Abstract: BACKGROUND: Subfoveal choroidal neovascularization is a main cause of blindness. The new surgical technique of macular translocation conceived by De Juan, with scleral shortening and without a retinotomy, allows to move the fovea away from the neovascular membrane with a low rate of complications. The first results obtained with this technique are presented here, in cases of submacular neovascularization due to age-related macular degeneration (AMD) or degenerative myopia. PATIENTS AND METHODS: The first 10 patients who were operated on with this technique presented with subfoveal neovascularization due to AMD (6 eyes) or myopia (4 eyes). The time period between the beginning of the disease and surgery was less than 3 months. Before and after surgery, a complete examination included fluorescein and ICG angiographies and OCT. RESULTS: Visual acuity improved by 2 lines or more in 6 eyes (60%), was unchanged in 3 eyes (30%) and decreased in 1 eye. The improvement in vision seemed higher in myopia than in ARMD. Conversely, the mean foveal displacement was greater in ARMD than in myopia (1.2 disc diameter and 0.5 respectively). Laser photocoagulation has been performed in all patients after surgery. Main complications were retinal detachment (1 eye) and neovascularization at the site of transretinal injection (1 eye). Mean follow-up was 3 months. COMMENTS: Macular translocation with the technique described by De Juan allowed visual improvement in more than the half of the eyes with subfoveal neovascularization, resulting in a moderate rate of complications. Long term follow-up is necessary to confirm these results.

Leveziel N, Delcourt C, Zerbib J, Dollfus H, Kaplan J, Benlian P, Coscas G, Souied EH, Soubrane G. · Service d'ophtalmologie, centre hospitalier intercommunal de Créteil, 40 Avenue de Verdun, 94000 Créteil. · J Fr Ophtalmol. · Pubmed #19515460 No free full text.

Abstract: Age-related macular degeneration (ARMD) is a multifactorial and polygenic disease and is the main cause of vision loss in developed countries. The environmental factors of ARMD can modify prevalence and incidence of this disease. This article is a review of the main environmental factors currently recognized as at risk or protective factor for ARMD. Modification of these factors is of crucial importance because it could delay the onset of exudative or atrophic forms of the disease.

Querques G, Regenbogen M, Soubrane G, Souied EH. · Department of Ophthalmology, University of Paris XI, Creteil, France. · Surv Ophthalmol. · Pubmed #19298908 No free full text.

Abstract: We describe the abnormalities seen in the mid periphery and posterior pole of two patients with multifocal vitelliform macular dystrophy as evaluated by high-definition spectral domain optical coherence tomography (HD-OCT). In patient 1, HD-OCT scans revealed, in the central area, a thicker and more reflective layer compared with the normal macula, located between the retinal pigment epithelium and the interface of the inner segment/outer segment, corresponding to the Verhoeff's membrane. Moreover, HD-OCT macular scans, as well as C-scans, revealed a slight hyper-reflective lesion just above an area of reduced reflectivity between the photoreceptor layer (interface of the inner segment and outer segment) and the Verhoeff's membrane. In patient 2, on HD-OCT macular scans, the layer corresponding to the interface of inner segment and outer segment of the photoreceptor, and the Verhoeff's membrane, appeared disrupted, whereas the retinal pigment epithelium layer appeared preserved. On the other hand, in both patient 1 and 2, the clinically evident vitelliform lesions outside the macular area appeared on HD-OCT scans either as small focal hyper-reflective lesions at the level of the retinal pigment epithelium/photoreceptor complex, either as a more pronounced diffuse thickening of the retinal pigment epithelium/photoreceptor complex, facing the deposition of lipofuscin reported on the histopathologic examination. These new findings would help in a further understanding of multifocal vitelliform macular dystrophy.

Semoun O, Guigui B, Tick S, Coscas G, Soubrane G, Souied EH. · Service Universitaire d'Ophtalmologie de Créteil, Université Paris 12, Faculté de médecine Henri Mondor, Centre Hospitalier Intercommunal de Créteil, Créteil, France. · Br J Ophthalmol. · Pubmed #18984656 No free full text.

Abstract: AIM: Wet age-related macular degeneration (AMD) represents a heterogeneous group of phenotypes, all defined by fluorescein angiography features (FA). Imaging of wet AMD is extensively described in literature, including colour pictures, FA, indocyanine green angiography (ICG) and optical coherence tomography (OCT). The purpose of this study was to describe features of infrared (IR) pictures of a homogeneous subgroup of classic choroidal neovascularisation (CNV) associated with wet AMD, METHODS: We analysed 22 eyes of 22 consecutive patients with classic CNV. All patients underwent a complete ophthalmological examination including colour fundus photography, infrared picture, fluorescein angiography, indocyanine green angiography and an optical coherence tomography. RESULTS: Infrared pictures revealed a whitish ring surrounding the neovascular lesion in all eyes (22/22). The whitish ring corresponded in all cases to the borders of the CNV defined on the early phase of FA and ICG pictures. The ring had an "O-shape" in 15/22 cases (68%) and a "U-shape" in 7/22 cases (32%). CONCLUSION: Analysis of infrared pictures in classic CNV constantly revealed a whitish ring that is correlated to the limits of the lesion. IR picture is a non invasive imaging of the macula, but the specificity of the features needs to be investigated in further studies.

Angulo Bocco MC, Glacet-Bernard A, Zourdani A, Coscas G, Soubrane G. · Service d'Ophtalmologie, Hôpital Intercommunal, Créteil, France. · J Fr Ophtalmol. · Pubmed #18971854 No free full text.

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

Fletcher AE, Bentham GC, Agnew M, Young IS, Augood C, Chakravarthy U, de Jong PT, Rahu M, Seland J, Soubrane G, Tomazzoli L, Topouzis F, Vingerling JR, Vioque J. · Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, England. · Arch Ophthalmol. · Pubmed #18852418 No free full text.

Abstract: OBJECTIVE: To examine the association of sunlight exposure and antioxidant level with age-related macular degeneration (AMD). METHODS: Four thousand seven hundred fifty-three participants aged 65 years or older in the European Eye Study underwent fundus photography, were interviewed for adult lifetime sunlight exposure, and gave blood for antioxidant analysis. Blue light exposure was estimated by combining meteorologic and questionnaire data. RESULTS: Data on sunlight exposure and antioxidants were available in 101 individuals with neovascular AMD, 2182 with early AMD, and 2117 controls. No association was found between blue light exposure and neovascular or early AMD. Significant associations were found between blue light exposure and neovascular AMD in individuals in the quartile of lowest antioxidant level-vitamin C, zeaxanthin, vitamin E, and dietary zinc-with an odds ratio of about 1.4 for 1 standard deviation unit increase in blue light exposure. Higher odds ratios for blue light were observed with combined low antioxidant levels, especially vitamin C, zeaxanthin, and vitamin E (odds ratio, 3.7; 95% confidence interval, 1.6-8.9), which were also associated with early stages of AMD. CONCLUSIONS: Although it is not possible to establish causality between sunlight exposure and neovascular AMD, our results suggest that people in the general population should use ocular protection and follow dietary recommendations for the key antioxidant nutrients.