Visual field defects are a world-wide concern, and the proportion of the population experiencing vision loss is ever increasing. Macular degeneration and glaucoma are among the four leading causes of ...permanent vision loss. Identifying and characterizing visual field losses from gaze alone could prove crucial in the future for screening tests, rehabilitation therapies, and monitoring. In this experiment, 54 participants took part in a free-viewing task of visual scenes while experiencing artificial scotomas (central and peripheral) of varying radii in a gaze-contingent paradigm. We studied the importance of a set of gaze features as predictors to best differentiate between artificial scotoma conditions. Linear mixed models were utilized to measure differences between scotoma conditions. Correlation and factorial analyses revealed redundancies in our data. Finally, hidden Markov models and recurrent neural networks were implemented as classifiers in order to measure the predictive usefulness of gaze features. The results show separate saccade direction biases depending on scotoma type. We demonstrate that the saccade relative angle, amplitude, and peak velocity of saccades are the best features on the basis of which to distinguish between artificial scotomas in a free-viewing task. Finally, we discuss the usefulness of our protocol and analyses as a gaze-feature identifier tool that discriminates between artificial scotomas of different types and sizes.
Purpose
The clinical utility of rituximab (RTX) in Graves’ orbitopathy (GO) treatment remains controversial since the discrepant results from 2 prospective randomized studies (Stan M et al. J Clin ...Endocrinol Metab 2015; Salvi M et al. J Clin Endocrinol Metab 2015).
The aim of this study was to assess in real life the characteristics and the clinical outcomes of patients with GO treated with RTX in cases of corticosteroid resistance or corticosteroid dependence.
Methods
Multicenter French retrospective study including patients with moderate-to-severe GO requiring second-line treatment with RTX. Patients were classified according to three main baseline characteristics: clinical inflammation (CAS ≥ 3), oculomotor limitation, and visual dysfunction. Patients were considered as responders if, at 24 weeks (week 24), at least 1 of these 3 parameters improved with no worsening elsewhere.
Results
Forty patients were included (65% smokers, 38% dysthyroidism). Thirty-two patients were treated with RTX alone (one patient excluded owing to side effects): 64.5% had favorable responses at week 24 and significant reduction in baseline CAS (3.29 ± 1.6) at 12 weeks (1.93 ± 1.1;
P
< 0.001) and at week 24 (1.59 ± 1.1;
P
< 0.001); reduction in anti-TSH receptor antibodies at week 24 (
P
< 0.01); and significant improvement of visual acuity (
P
= 0.04) and ocular hypertonia (
P
= 0.04) at week 12, but no improvement in oculomotor dysfunction. Eight patients needed emergency treatment with concomitant RTX and orbital decompression, with favorable outcome for 5 patients. Predictive factors for a poor response to RTX were low baseline CAS, smoker, and baseline ocular hypertonia. All patients reported good tolerance except one serious side effect (a cytokine release syndrome).
Conclusions
The efficiency results of RTX in reducing CAS in this cohort are just between those of Stan and Salvi. This could be explained by our delay before treatment initiation, quicker than Stan but longer than Salvi. RTX appears to be effective as a second-line treatment for the inflammatory component of GO, especially if the disease is highly active and recent.
Purpose: The aim of this study was to further explore the efficacy and safety of interferon-α in refractory non-infectious inflammatory macular edema and to compare interferon-α2a and pegylated ...interferon-α2b.
Methods: 34 patients with refractory non-infectious uveitic macular edemaunder interferon-α were retrospectively reviewed.
Results: Mean baseline best-corrected visual acuityimproved from 0.55 logMar to 0.37 logMAR (P < 0.001) at month (M) 1 and 0.40 logMAR (P < 0.001) at M6. The mean baseline CMT decreased from 554 µm to 367 µm (P < 0.001) at M1 and 394 µm (P < 0.001) at M6. Clinical adverse effects (AEs) were observed in a third of patients, leading to treatment discontinuation because of frequent mild AEs and few severe AE. No statistically significant difference was found between both molecules.
Conclusions: Anatomically and functionally, interferon-α was rapidly effective despite a low dosage regimen and no difference in efficacy and tolerance was observed between interferon-α2a and pegylated interferon-α2b.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Abnormal torsion could be associated with cyclovertical strabismus, but torsion measurements are not reliable in children. To assess an objective fundus torsion evaluation in a paediatric population, ...we used Non-Mydriatic Fundus photography (NMFP) in healthy and cyclovertical strabismus patients to evaluate the disc-foveal angle over time and observers.
We used a retrospective set of NMFP including 24 A or V-pattern strabismus and 27 age-matched normal children (mean age 6.4 and 6.7 years respectively), taken during 2 distinct follow-up consultations (separated by 251 and 479 days respectively). Each disc-foveal angle measurement (from which the ocular torsion can be assessed) was performed by 5 different observers, using graphical software and based on reproducible fundus anatomical marks. Statistical analysis was performed with a multivariate ANOVA using group, time and observers as factors, in addition to intraclass coefficient correlation (ICC) to assess measurement reproducibility.
A significant difference of disc-foveal angle measures was observed between groups (p<0,001): 18.73° (SD = 6.42), -3,25° (SD = 5.51) and 6,89° (SD = 4,41) respectively for V-pattern, A- pattern and normal subjects. Neither observers (F = 0,2028 p = 0,9369) nor time between 1st and 2nd NMFP (F = 0,6312 p = 0,4271) seem to influence the measure of disc-foveal angle. The evaluation of disc-foveal angle was very reproducible between observers (ICC>0,97).
Abnormal amount of objective torsion could be associated with alphabet-pattern strabismus. Disc-foveal angle evaluation by NMFP in a children population appears as a non-invasive, reliable and reproducible method.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Introduction
Cataract surgery is the most common surgical procedure performed in France. While the incidence of intraoperative complications affecting visual prognosis is extremely low, given the ...large number of patients operated on, the absolute number of patients affected by complications is quite high. Complication rates are significantly higher when ophthalmology residents (ORs) perform the surgery. Although lack of experience remains the main risk factor, sleep deprivation may adversely affect ORs’ successful surgery rate. The value of the EyeSi® surgical simulator in initial training has been demonstrated to increase cataract surgery safety through the transfer of surgical skills from the simulator to the operating room. However, there is no consensus regarding how much training is needed before the first-time ORs are allowed to operate. There is also no scientific evidence that sleep deprivation is associated with a decrease in surgical performance. Establishing a validated protocol for cataract surgery training using the EyeSi surgical simulator (referred to further as the EyeSi) and identifying risk factors for intraoperative complications related to sleep deprivation will improve cataract surgery safety and lead to the reorganization of our healthcare systems.
Methods and Planned Outcomes
This multi-centre educational cohort study will include two distinct axes which will both aim to reduce the risks of cataract surgery. Enrollment will include 16 first-year ORs for Axis 1 and 25 experienced residents for Axis 2, all from the University Hospitals of Nantes, Tours, Angers and Rennes. Axis 1 will focus on investigating the learning curve of first-year ORs using the EyeSi, following the training program recommended by the “College des Ophtalmologistes Universitaires de France” in order to set up a future “licence to operate.” Axis 2 will evaluate the impact of sleep deprivation on the surgical performance of experienced ORs using the EyeSi.
Trial Registration
ClinicalTrial.gov identifier: NCT05722080.
Abstract Introduction Congenital primitive glaucoma (CPG) is a rare and sight threatening condition. In the surgical management of CPG, deep sclerectomy (DS) is a technique of choice but the ...long-term results are not well documented. Purpose To estimate long term future of pressure and vision of children who underwent DS for CPG. Material and Methods Children affected by CPG, aged from 1 day to 3 years at the time of the diagnosis were retrospectively included between 1999 and 2014. All benefited from a DS with use of antimetabolites. Preoperative and long-term post-operative intraocular pressures (IOP), per and postoperative complications as well as visual acuity and refractive status were estimated. Complete IOP control was defined by a postoperative IOP ≤16 mmHg without medical treatment. Results 141 eyes of 71 children were included (sex ratio: 1.02). Mean follow-up was 56.6 ±9.6 months. Final average IOP among the whole sample was 11.3 +/-7 mmHg. The rate of total success was 69.4 %, partial success 27.6 % and 3 % failure at the last check. No complications were seen in 85.1 % of cases (n=120 eyes). Among 37 children analyzed for visual acuity, maintained visual acuity was found in 50 % of cases (n= 37 eyes). Discussion and Conclusion DS allows obtaining good IOP control with a very low rate of complications, and should be considered as a technique of choice in the surgical management of CPG. This study is of particular relevance because it has been led on a long term period and on an important staff considering the rare prevalence of the condition.
Faux œdèmes papillaires Lebranchu, Pierre
Revue neurologique,
April 2015, 2015-04-00, Letnik:
171
Journal Article
Recenzirano
La papille peut adopter un aspect gonflé, non secondaire à un œdème des axones en cas de malformations congénitales, d’infiltration ou de druse.
Les amétropies peuvent s’associer à une petite papille ...saillante (hypermétrope) ou une surélévation d’une partie de l’anneau (dysversion myopique). Des anomalies congénitales peuvent être asymptomatiques (fibres à myéline, papille de Bergmeister, mélanocytome) ou provoquer une baisse plus ou moins importante de l’acuité visuelle (colobome, morning glory, hypopolasie).
Une infiltration du nerf optique peut être secondaire à une pathologie granulomateuse (sarcoïdose) ou tumorale (leucémies, lymphome), combinant mécanismes infiltratif et compressif. La papille apparaît alors souvent blanche ou grisâtre, entourée d’hémorragies ou de signes inflammatoires.
Les druses papillaires correspondent à des dépôts calciques acellulaires plus ou moins profonds. Si le diagnostic est aisé en cas d’atteinte superficielle, l’atteinte profonde du sujet jeune peut mimer un œdème. Les druses ont souvent une évolution lente et bénigne. Cliniquement, la papille présente un bord festonné, sans hyperhémie ni masquage des vaisseaux superficiels, parfois associé à une vascularisation rétinienne anormale (ramification précoce, vaisseaux surnuméraires, tortuosité vasculaire). La littérature n’est pas claire sur leur aspect en tomographie par cohérence optique (OCT) : élévation de la tête du nerf optique et de la rétine adjacente par des espaces ronds et hyporéfléctifs (optiquement vides) ; régions pauvres en signal, entourés de petites bandes hyper-réflectives ; masse hyper-réflective avec un bord clairement individualisable par rapport aux couches nucléaires et pléxiformes internes adjacentes. Cependant, la pertinence de leur diagnostic sur l’analyse OCT reste faible, comprise entre 50 et 64 %. L’autofluorescence spontanée de la tête du nerf optique n’est pas systématique, mais sa présence oriente fortement le diagnostic. L’échographie en mode B semble parfois plus sensible, objectivant la surélévation papillaire associée à du matériel hyperéchogène. Enfin le scanner peut mettre en évidence des druses profonds calcifiés.
OBJECTIVETo describe clinical and radiologic features associated with myelin oligodendrocyte glycoprotein antibodies (MOG-Ab) in a large French nationwide adult cohort, to assess baseline prognostic ...features of MOG-Ab–associated diseases after a first acute demyelinating syndrome, and to evaluate the clinical value of MOG-Ab longitudinal analysis.
METHODSClinical data were obtained from 197 MOG-Ab–positive patients ≥18 years of age. Complete imaging data were available in 108, and 54 serum samples were eligible for longitudinal evaluation. For survival analysis comparison, 169 aquaporin-4 antibody (AQP4-Ab)–positive patients from the NOMADMUS database were included.
RESULTSMedian age at onset was 36.46 (range 18.0–76.8) years, and patients were predominantly white (92.9%) with male:female ratio, 1.1. Clinical phenotype at onset included optic neuritis or myelitis in 90.86%, isolated brainstem or encephalopathy syndromes in 6.6%, and a combination of syndromes in 2.5%. Distinctive brain MRI findings in MOG-Ab–positive patients were thalamic and pontine lesions. Cortical and leptomeningeal lesions were found in 16.3% and 6.1%, respectively. The probability of reaching a first relapse after 2 and 5 years was 44.8% and 61.8%, respectively. MOG-Ab–positive patients were at lower risk at presentation of further clinical relapse (hazard ratio HR 0.45, 95% confidence interval CI 0.26–0.79) compared to AQP4-Ab–positive individuals. MOG-Ab–positive individuals had a lower risk of reaching Disability Status Scale score of 3.0 (HR 0.46, 95% CI 0.22–0.94) and visual acuity of 20/100 (HR 0.23, 95% CI 0.07–0.72). Finally, MOG-Ab titers were higher at relapse than in remission (p = 0.009).
CONCLUSIONIn adults, MOG-Ab–associated disease extends beyond clinical and radiologic abnormalities in the optic nerve and spinal cord. Despite the relapsing course, the overall visual and motor outcome is better compared with AQP4-Ab–positive patients.
The aim of this study was the evaluation of the safety and efficacy of unilateral subretinal injection of the adeno-associated vector (AAV) serotypes 2 and 4 (AAV2/4) RPE65-RPE65 vector in patients ...with Leber congenital amaurosis (LCA) associated with RPE65 gene deficiency. We evaluated ocular and general tolerance and visual function up to 1 year after vector administration in the most severely affected eye in nine patients with retinal degeneration associated with mutations in the RPE65 gene. Patients received either low (1.22 × 1010 to 2 × 1010 vector genomes vg) or high (between 3.27 × 1010 and 4.8 × 1010 vg) vector doses. An ancillary study, in which six of the original nine patients participated, extended the follow-up period to 2–3.5 years. All patients showed good ophthalmological and general tolerance to the rAAV2/4-RPE65-RPE65 vector. We observed a trend toward improved visual acuity in patients with nystagmus, stabilization and improvement of the visual field, and cortical activation along visual pathways during fMRI analysis. OCT analysis after vector administration revealed no retinal thinning, except in cases of macular detachment. Our findings show that the rAAV2/4.RPE65.RPE65 vector was well tolerated in nine patients with RPE65-associated LCA. Efficacy parameters varied between patients during follow-up.
First results of a phase I/II clinical trial with an AAV serotype 4 vector in Leber congenital amaurosis associated with RPE65 gene deficiency are reported. The vector is well tolerated after subretinal injection. Efficacy parameters varied between patients during follow-up.
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.
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