Purpose: What is the proportion of MOG‐Ab among optic neuritis (ON) in adults and what would be the ON presentation for which MOG‐Ab should be tested?
Methods: Multicentric prospective study ...conducted during one year on all patients diagnosed with acute ON in all ophthalmologic units in hospitals of a region in western France.
Results: Sixty‐five patients were included. MOG‐Ab prevalence was 14% (9/65) during an acute ON and 13% (7/55) after exclusion of patients already diagnosed as multiple sclerosis (MS) (8) or MOG + ON (2). Compared to multiple sclerosis (MS) and clinically isolated syndrome (CIS), MOG + ON had no female preponderance (respectively 67% of men versus 22%, p < 0.05), were more often bilateral (44% versus 3%, p < 0.005) and associated with optic disc swelling (ODS) (78% versus 14%, p < 0.001). To predict MOG + ON, the combined factor “ODS or bilateral or recurrent ON” was the best compromise between positive predictive value (31% 95% CI 14;48) and negative predictive value (100% 100;100).
Discussion: These results corroborate other studies that estimated MOG‐Ab prevalence among ON: between 10 to 31% in four retrospective studies and 4% (2/51) in a prospective study. AQP4‐Ab prevalence is higher in Asia (36 to 42%) than in Europe (5%). Furthermore, our study supports the clinical findings of large retrospective collections of MOG + ON patients: MOG + ON occurs in similar age as MS without female preponderance, optic disc swelling and bilateral involvement are common, response to corticosteroid treatment is good and most patients retain functional vision. We found that longitudinal optic nerve lesions and optic nerve perineuritis were significantly associated with MOG + ON. These results corroborate findings of Chen et al. Among ON, Jarius et al. recommended testing MOG‐Ab only in cases of ODS, bilateral ON, severe ON, steroid dependent symptoms and frequent relapses. This expert advice is based on retrospective studies that are unable to evaluate the predictive value of such features. In our series, we validated predictive value of ODS and bilateral involvement. Their PPV is middling but their high NPV make them relevant. We could not validate the other features. Our study highlights the importance of determining ODS in cases of initial ON, in particular as this feature could be absent due to optic disc atrophy due to recurrence. Notably, the two MOG+ patients who did not have ODS during this study were recurrent ON; however, subsequent review of their records revealed ODS during their 1st episode. Testing MOG‐Ab only in the case of ODS or bilateral or recurrent ON would limit MOG‐Ab testing to 29 among 65 patients (45%) and would ensure that MOG + ON would not be missed.
Conclusion: Among ON episode, MOG‐Ab were found in 14% of cases. MOG + ON occurred without female preponderance and was significantly associated with ODS and/or bilateral ON. Testing MOG‐Ab only in patients presenting with ODS or bilateral or recurrent ON would limit MOG‐Ab tests to fewer than half of all patients without the risk of missing any MOG + ON cases.
Background
The 30‐day readmission rate provides a standardised quantitative evaluation of some postoperative complications. It is widely used worldwide in many medical and surgical specialities, and ...the World Health Organization recommends its use for monitoring healthcare system performance. In ophthalmology, its measurement is biased by the frequent and close planned surgery on one eye and then the other, particularly in the case of cataract surgery. This study measures the 30‐day unplanned readmission rate in ophthalmology, globally and by surgery subtype, and describes the causes of readmission.
Methods
All patients readmitted within 30 days of ophthalmic surgery at Nantes University Hospital between January 2017 and December 2020 were identified in the Medical Information System. An ophthalmologist examined each medical record and collected the following data: the reason for readmission, comorbidities, the pathology treated, surgery type, surgery duration, the surgeon's experience, anaesthesia type, severity and readmission morbidity.
Results
For the 8522 ophthalmic surgeries performed in the four‐year study period, 282 30‐day unplanned readmissions were identified. The overall 30‐day unplanned readmission rate was 2.07% for elective surgery, with a high variability depending on the surgery type: 0.95% for phacoemulsification, 4.95% for vitreoretinal surgery (3.42% for non‐elective vitreoretinal surgery, 5.44% for retinal detachment surgery), 5.66% for deep lamellar keratoplasty and 11.90% for trabeculectomy. The unplanned 30‐day readmission rate for ocular trauma surgery (emergency care) was 11.0%. Seven percent of all unplanned 30‐day readmissions were not associated with an ophthalmological problem.
Conclusions
This study is the first to report 30‐day unplanned readmission in ophthalmology, globally and by surgical subtype, for elective and urgent procedures. This indicator can be used longitudinally to detect an increase in risk or transversely to compare the quality of care between different public or private hospitals.
What is the proportion of antibodies to myelin oligodendrocyte glycoprotein (MOG-Ab) in optic neuritis (ON) in adults and what would be the ON presentation for which MOG-Ab should be tested?
...Multicentric prospective study conducted during 1 year on all patients diagnosed with acute ON in all ophthalmological units in hospitals in a region in western France.
Sixty-five patients were included. MOG-Ab prevalence was 14% (9/65) during an acute ON and 13% (7/55) after exclusion of patients already diagnosed with multiple sclerosis (MS) (8) or MOG+ON (2). Compared with MS and clinically isolated syndrome, MOG+ON had no female preponderance (67% of men in case of MOG+ON and 22% of men in case of MS and clinically isolated syndrome, p<0.05) were more often bilateral (44% vs 3%, p
0.005) and associated with optic disc swelling (ODS) (78% vs 14%, p
0.001). To predict MOG+ON, the positive predictive values (PPVs) of male sex, ODS and bilateral involvement were 29% (95% CI 9% to 48%), 41% (95% CI 18% to 65%) and 40% (95% CI 10% to 70%), respectively, while the negative predictive values (NPV) were 93% (95% CI 86% to 100%), 96% (95% CI 90% to 100%) and 91% (95% CI 83% to 99%), respectively. The combined factor 'ODS or bilateral or recurrent ON' was the best compromise between PPV (31% (95% CI 14% to 48%)) and NPV (100% (95% CI 100% to 100%)).
Among ON episodes, MOG-Ab were found in 14% of cases. MOG+ON occurred without female preponderance and was significantly associated with ODS and/or bilateral ON. Testing MOG-Ab only in patients presenting with ODS or bilateral or recurrent ON would limit MOG-Ab tests to fewer than half of all patients without the risk of missing any MOG+ON cases.
Purpose
The aim of this study was to evaluate the impact of adherence to French coronavirus disease 2019 (COVID 19)‐related guidelines for intravitreal injection (IVI) practice on the visual outcomes ...of patients treated with anti‐vascular endothelial growth factor (VEGF) agents for macular diseases during the first lockdown period.
Methods
Observational multicentre study including all patients from 18 centres with an IVI initially planned during the lockdown. Visual acuity (VA, ETDRS) was recorded at 1 and 4 months after lockdown. French COVID 19‐related guidelines recommended maintaining IVI practice. We defined three groups of patients: A, adherent to guidelines; NA+, non‐adherent with delayed IVIs; and NA−, non‐adherent without IVIs performed during the lockdown. Risk factors for non‐adherence and visual loss were studied.
Results
A total of 3020 eyes of 3020 patients, aged 77.8 ± 11.6 years, 59.8% women, were included. 59.3% were non‐adherent(46.7% NA+, 12.6% NA−). A smaller decrease in VA at 4 months was observed in the A group than the NA+ and NA− group (−0.2 ± 6.7, −0.3 ± 6.9 and −1.5 ± 6.9, respectively p < 0.001). Factors associated with non‐adherence were in multivariable analysis, older age, hospital practice, low‐density population areas, high viral incidence areas, longer intervals between injection and treat and extent protocol. Factors associated with visual loss at 4 months in multivariable analysis were, being in the NA− group, older age, T&E and fixed regimens.
Conclusion
Strict adherence to guidelines was associated with better visual outcome, although most of our patients did not attend as planned. Identification of patients at risk could help in the future in case of a new pandemic lockdown.
Purpose
To measure the predictive values of relative afferent pupillary defect (RAPD) assessed semi‐quantitatively, and visual acuity (VA) at onset of central retinal vein occlusion (CRVO), for ...neovascularization.
Methods
Retrospective analysis of the TROXHEMO trial that included patients with CRVO within 30 days after the onset. Inclusion criteria were as follows: semi‐quantitative RAPD assessment at diagnosis and/or at one month. RAPD was ‘severe’ if ≥ 0.9 log. Exclusion criteria were as follows: prophylactic panretinal photocoagulation (PRP) before neovascularization.
Results
Among the 119 patients enrolled in the main centre, 101 were analysed. 26 had a neovascular complication during the twelve months of follow‐up: rubeosis (19), glaucoma (7) and posterior neovascularization (15). The mean time to onset of a neovascular complication was 4.7 months (1 to 12, median 3 months). All the patients who had a neovascular complication had RAPD at first examination or at one month (negative predictive value (NPV) = 100%) but the positive predictive value (PPV) was low (31%, 95% CI 21%; 42%). The association ‘severe RAPD or VA < 35 letters (ETDRS) at inclusion or at one month’ was the best compromise between PPV (53%, 39%; 68%) and NPV (96%, 92%; 100%).
Conclusion
To predict neovascularization, RAPD should be routinely evaluated with filters: the risk of neovascular complication is (a) almost nil if there is no RAPD, (b) very low if there is no severe RAPD and if VA is higher than 35 letters, and (c) higher than 50% if RAPD is ≥ 0.9 log or if VA is less than 35 letters.
Decades of biological and clinical research have led to important advances in recombinant adeno-associated viruses rAAV-based gene therapy gene therapy. However, several challenges must be overcome ...to fully exploit the potential of rAAV vectors. Innovative approaches to modify viral genome and capsid elements have been used to overcome issues such as unwanted immune responses and off-targeting. While often successful, genetic modification of capsids can drastically reduce vector yield and often fails to produce vectors with properties that translate across different animal species, such as rodents, non-human primates, and humans. Here, we describe a chemical bioconjugation strategy to modify tyrosine residues on AAV capsids using specific ligands, thereby circumventing the need to genetically engineer the capsid sequence. Aromatic electrophilic substitution of the phenol ring of tyrosine residues on AAV capsids improved the in vivo transduction efficiency of rAAV2 vectors in both liver and retinal targets. This tyrosine bioconjugation strategy represents an innovative technology for the engineering of rAAV vectors for human gene therapy.
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•rAAV gene therapy advances face challenges like immune responses and off-targeting.•Bioconjugation targets tyrosine residues on rAAV, enhancing in vivo efficiency.•Chemical modification of tyrosine boosts rAAV2 transduction in liver and retina.•Tyrosine bioconjugation offers a non-genetic method for rAAV vector engineering.
In living children, the use of a wide field fundus camera such as RetCam is the gold standard practice to document retinal haemorrhages in suspected cases of abusive head trauma (AHT). In case of ...sudden unexpected death in infancy (SUDI), child abuse must be considered as a possible cause of death and an eye examination is required. However, no example of post-mortem fundus photograph (PMFP) of retinal haemorrhages related to AHT is yet available for clinicians.
We report a SUDI case, with no external traumatic lesions or limb fractures, for which prompt PMFP showed retinal haemorrhages typical of AHT: child abuse was subsequently confirmed by the forensic investigation. We discuss why PMFP is a relevant screening test to detect retinal haemorrhages in the case of SUDI and why the use of the RetCam should be further investigated.
Optic neuritis classification in 2021 Ducloyer, Jean-Baptiste; Marignier, Romain; Wiertlewski, Sandrine ...
European Journal of Ophthalmology,
03/2022, Letnik:
32, Številka:
2
Book Review, Journal Article
Recenzirano
Optic neuritis (ON) can be associated with inflammatory disease of the central nervous system or can be isolated, with or without relapse. It can also be associated with infectious or systemic ...disease. These multiple associations based on a variety of clinical, radiological, and biological criteria that have changed over time have led to overlapping phenotypes: a single ON case can be classified in several ways simultaneously or over time. As early, intensive treatment is often required, its diagnosis should be rapid and precise. In this review, we present the current state of knowledge about diagnostic criteria for ON aetiologies in adults and children, we discuss overlapping phenotypes, and we propose a homogeneous classification scheme. Even if distinctions between typical and atypical ON are relevant, their phenotypes are largely overlapping, and clinical criteria are neither sensitive enough, nor specific enough, to assure a diagnosis. For initial cases of ON, clinicians should perform contrast enhanced MRI of the brain and orbits, cerebral spinal fluid analysis, and biological analyses to exclude secondary infectious or inflammatory ON. Systematic screening for MOG-IgG and AQP4-IgG IgG is recommended in children but is still a matter of debate in adults. Early recognition of neuromyelitis optica spectrum disorder, MOG-IgG-associated disorder, and chronic relapsing idiopathic optic neuritis is required, as these diagnoses require therapies for relapse prevention that are different from those used to treat multiple sclerosis.
Introduction
In the case of sudden unexpected death in infancy (SUDI), eye examination is systematic to detect retinal hemorrhages (RH) that are a crucial hallmark for abusive head trauma (AHT). The ...aim of this study is to assess the ability of non-invasive post-mortem fundus photographs (PMFP) to detect RH in case of SUDI.
Methods
Bicentric retrospective analysis of consecutive cases of SUDI under 2 years of age were managed by two French SUDI referral centers with PMFP by RetCam (Clarity Medical Systems USA). PMFP were reviewed randomly, twice, by three independent ophthalmologists blinded for clinical data.
Results
Thirty cases (60 eyes) were included. Median age was 3.5 months (interquartile 1.6; 6.0). No child died of AHT. Image quality was sufficient to assert presence or absence of RH in 50 eyes (83%). Sufficient quality rate was significantly higher when the post-mortem interval was inferior to 18 h (91%, 42/46) as opposed to over 18 h (57%, 8/14,
p
=0.0096). RH were found in six eyes (10%), four children (13%), with excellent inter and intra-raters’ concordance (Cohen’s Kappa from 0.81 0.56–1.00 to 1.00 1.00–1.00).
Conclusion
PMFP can detect RH in case of SUDI and is a relevant systematic screening test to be carried out as soon as the deceased child arrives in the hospital. It can decrease the need of eye removal for pathological examination, but further studies are needed to define the best decision algorithm.
Les rétinites pigmentaires, ou dystrophies rétiniennes héréditaires, sont des maladies dégénératives cécitantes d’origine génétique. La thérapie génique est une approche révolutionnaire en plein ...essor qui ouvre la voie au traitement de maladies jusqu’ici incurables. Une thérapie génique, le Luxturna®, a obtenu une autorisation de mise sur le marché par la FDA (
Food and Drug Administration
) fin 2017 et l’EMA (
European Medicines Agency
) fin 2018. Ce traitement, à l’efficacité démontrée, destiné aux patients porteurs d’une amaurose congénitale de Leber ou d’une rétinopathie pigmentaire en lien avec une mutation bi-allélique du gène
RPE65
, apporte beaucoup plus de questions que de réponses. Nous présentons, dans cette revue, les avancées actuelles, puis les défis technologiques, économiques et éthiques à surmonter pour que la thérapie génique améliore nos pratiques médicales.
Retinitis pigmentosa is the most common blinding inherited retinal dystrophy. Gene therapy is a burgeoning revolutionary approach that paves the way to treatment of previously incurable diseases. At the end of 2017 and 2018, a gene therapy, Luxturna
®
, obtained a marketing authorization by respectively the FDA (Food and Drug Administration) and the EMA (European Medicines Agency). This treatment, with proven efficacy, is available to patients with Leber congenital amaurosis and retinitis pigmentosa associated with bi-allelic mutations of the RPE 65 gene. In this paper, we present the current advances in gene therapy for retinitis pigmentosa and discuss the technological, economic and ethical challenges to overcome for gene therapy to improve medical practices.
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