PURPOSE: To describe the demographic and clinical characteristics of pediatric patients presenting with papilledema in a tertiary university center. PATIENTS AND METHODS: This study is a single-center retrospective study...PURPOSE: To describe the demographic and clinical characteristics of pediatric patients presenting with papilledema in a tertiary university center. PATIENTS AND METHODS: This study is a single-center retrospective study of papilledema in patients under 18 years of age between January 2013 and January 2023. Visual acuity, visual field defects and retinal nerve fiber layer thickness were recorded at the beginning and conclusion of follow-up. The etiological diagnosis was established based on ocular and physical clinical examination, brain imaging and cerebrospinal fluid analysis. RESULTS: Eighty-five patients (162 eyes) were included. The mean age at diagnosis was 9.0±5.7 years, ranging from 0.1 to 17.9 years, with a mean follow-up of 15.6±19.1 months. The main etiology of papilledema, affecting 63 patients, was secondary intracranial hypertension (74.1%), mostly due to intracranial masses (20%), intracranial hemorrhages/hematomas (16.5%), and cerebral venous thrombosis (9.4%). Twenty-two patients (25.9%) had idiopathic intracranial hypertension. During follow-up, 6 patients (7.1%) died from their condition. CONCLUSION: In our tertiary center, the leading cause of papilledema was secondary intracranial hypertension, which differs from results of primary, secondary, or outpatient settings. Our study highlights the need for multidisciplinary approach in diagnosis and management of children with papilledema. These findings might guide clinicians in their evaluation of the underlying etiology.
PURPOSE: To evaluate the practices of French ophthalmologists in the management of neovascular age-related macular degeneration (nAMD) with regard to the identification of criteria influencing therapeutic decision-making...PURPOSE: To evaluate the practices of French ophthalmologists in the management of neovascular age-related macular degeneration (nAMD) with regard to the identification of criteria influencing therapeutic decision-making and motivating the need for a new molecule. METHODS: A survey of practices based on the validated case-vignette method was conducted from January to September 2023 and included 110 ophthalmologists throughout France. A total of 480 clinical cases were developed based on disease progression (worsening, stability, improvement), the presence or absence of exudative signs (intraretinal fluid, subretinal fluid, or subretinal hyperreflective material), and the volume of retinal fluid (obvious or subtle). For each case, ophthalmologists assessed whether to continue the current anti-VEGF treatment or change the injection interval and/or molecule, and they assessed the benefit of having a new molecule available. RESULTS: In 76.9% of cases, clinical cases showed disease activity (56.5% worsening and 20.4% disease stability). The fluid present was mostly subtle in 55% of the cases and obvious in 38.8% of the cases. Among the responding physicians, 82.5% intended to change the treatment entirely, and 71.8% opted to change only one parameter (molecule or treatment interval). The common criterion for a change in treatment was disease worsening. For the same clinical case, 92% of those who opted for a single change and 87% of those who opted for a change in interval and molecule would consider it relevant to propose a new anti-VEGF. Among the physicians, 55.8% would maintain the treatment interval identical to that of the previous treatment. The most common criteria for the need for a new molecule was the obvious presence of exudative signs (P<0.001), treatment every≤6weeks (P<0.001), initial treatment for 3-6months (P<0.001), and visual acuity of 20/200 (P<0.001). CONCLUSION: This survey provides an overview of current management strategies for patients with nAMD in France and identifies criteria influencing therapeutic decision-making based on different patient profiles. This highlights the interest of ophthalmologists in having new molecules to treat insufficiently controlled patients.
INTRODUCTION: Corneal perforation is a progressive complication of Mooren's ulcer. Its management in African blacks is difficult and empirical. MATERIALS AND METHODS: We performed a prospective study over a 6-year period...INTRODUCTION: Corneal perforation is a progressive complication of Mooren's ulcer. Its management in African blacks is difficult and empirical. MATERIALS AND METHODS: We performed a prospective study over a 6-year period on black African patients with perforated Mooren's ulcers. They received medical and surgical treatment. RESULTS: Eighteen eyes of sixteen patients were included during the study period. The mean age was 29.54years with a sex ratio of 0.6. Six eyes were visually impaired, while ten eyes (55.6%) were blind. Corneal suturing combined with conjunctival advancement was performed in 72.2% of cases, and an amniotic membrane graft was used in 27.8%. Recurrence after treatment was observed in 33.3% of cases. In univariate analysis, predictive factors for recurrence include female gender, age under 30, and a delay until consultation of more than 3 months. CONCLUSION: Perforated Mooren's ulcer is a blinding disease in African blacks. Recurrence is frequent and requires special attention from the patient and the specialist. Amniotic membrane transplantation has proven to be an effective treatment.
Age-related macular degeneration (AMD) is a chronic disease whose progression toward advanced stages is closely related to the phenotype observed at the early and intermediate stages. The detection and characterization o...Age-related macular degeneration (AMD) is a chronic disease whose progression toward advanced stages is closely related to the phenotype observed at the early and intermediate stages. The detection and characterization of drusen and pigmentary abnormalities are central to the stratification of progression risk. Retro mode imaging, based on indirect infrared retro-illumination, enhances the visualization of retinal surface elevation, depth-related features, and variations in pigment density. This review examines the contribution of the various retro mode configurations (deviated left [DL]; deviated right [DR]; and ring aperture [RA]) in AMD, based on recent data in the literature as well as our clinical experience. When integrated into a multimodal imaging strategy, the combined use of DL and DR modes improves the detection and morphological assessment of drusen, while the ring aperture mode facilitates the identification of subtle pigment migration at the onset of the disease. A more precise characterization of these lesions allows refinement of AMD staging and provides clinically meaningful prognostic information.
PURPOSE: This is a proof-of-concept study of laser peripheral iridotomy (LPI) outcomes in phakic eyes with "dark-induced angle closure (AC) changes" (DACC). DACC was diagnosed gonioscopically in the dark as presence of t...PURPOSE: This is a proof-of-concept study of laser peripheral iridotomy (LPI) outcomes in phakic eyes with "dark-induced angle closure (AC) changes" (DACC). DACC was diagnosed gonioscopically in the dark as presence of traces of iridotrabecular contact (ITC) and/or a Shaffer angle≤20°. METHODS: We evaluated phakic adult outpatients. We recorded the retinal nerve fiber layer (RNFL) thickness, intraocular pressure (IOP), and performed gonioscopy in the dark to assess ITC traces and the Shaffer angle value. LPI was performed in both eyes using a YAG laser. RESULTS: We assessed the first treated eye of 114 patients (mean±standard deviation) age: 59.6±11.6; Caucasian: 82%, normal IOP without glaucoma: 92%; average or deep limbal anterior chamber: 78.1%. At baseline, the mean IOP was 15.6±3.4mmHg. The RNFL thickness was above the normal minimum value in 103 eyes, with, nonetheless, qualitative abnormalities/asymmetry in 107 eyes. Gonioscopy in the dark showed traces of ITC in all eyes and a Shaffer angle≤20° around the 6 o'clock meridian in 54 (47%). In all eyes, during the laser procedure, as soon as the iridotomy became wide enough, the aqueous humor from the posterior chamber burst forward into the anterior chamber, immediately deepening it. At the 12-month visit, the mean IOP had decreased by 1.7±2.0mmHg (P<0.001), and the mean RNFL had increased by 0.42±2.2μm (P=0.045). None of the 38 patients with a history of morning headaches experienced them after bilateral LPI. CONCLUSION: LPI provided favorable outcomes in eyes with DACC, suggesting DACC to be a clinical entity of early-stage AC. If confirmed in controlled studies, this approach might help to prevent AC and AC glaucoma.
PURPOSE: To determine the prevalence of non-exudative macular neovascularization (neMNV) in age-related macular degeneration (AMD) and to identify potential markers for activation and disease progression using findings f...PURPOSE: To determine the prevalence of non-exudative macular neovascularization (neMNV) in age-related macular degeneration (AMD) and to identify potential markers for activation and disease progression using findings from optical coherence tomography angiography (OCTA). MATERIALS AND METHODS: This retrospective longitudinal study included patients with treatment-naïve neMNV secondary to AMD who presented to a tertiary retina clinic between January 2021 and July 2024. Patients were evaluated using OCT and OCTA at each visit, with a definitive diagnosis of neMNV established using OCTA. Exclusion criteria included prior anti-VEGF therapy, pachychoroid spectrum diseases, vitreoretinal surgery, chorioretinal conditions, and unreliable OCTA images. Parameters assessed included best-corrected visual acuity (BCVA), and lens status. RESULTS: neMNV was identified in 186 out of 3119 patients (5.96%). The mean age was 72.73±8.60 years, with a mean follow-up of 22.11±7.51 months. Transition from the non-exudative to the exudative form occurred in 34 (18.3%) patients, with an average activation duration of 14.71±8.42 months. BCVA improved significantly in neMNV eyes over time (P<0.01) but remained stable in fellow eyes. No significant correlations were found between activation time and age, gender, or laterality. The prevalence of exudative MNV in fellow eyes was 67%. CONCLUSIONS: neMNV is relatively common among AMD patients, with a prevalence of 5.96%. Regular monitoring using OCTA is essential for early detection and management, given the significant potential for these lesions to progress to an exudative state. Future research should focus on identifying specific biomarkers and imaging characteristics predictive of neMNV activation.
PURPOSE: To evaluate the value of quantitative macular thickness mapping using spectral-domain optical coherence tomography (SD-OCT) as an early screening tool for preclinical hydroxychloroquine-induced retinal toxicity....PURPOSE: To evaluate the value of quantitative macular thickness mapping using spectral-domain optical coherence tomography (SD-OCT) as an early screening tool for preclinical hydroxychloroquine-induced retinal toxicity. METHODS: This observational cross-sectional study included 122 patients receiving hydroxychloroquine. Established hydroxychloroquine retinal toxicity was defined according to classical structural and functional criteria, including ellipsoid zone disruption on SD-OCT and confirmatory abnormalities on 10-2 visual field testing, fundus autofluorescence, and/or multifocal electroretinography. Patients fulfilling these criteria were identified separately and excluded from intergroup quantitative analyses. The remaining patients were stratified according to treatment duration into a higher-exposure group (≥ 5 years) and a lower-exposure group (< 5 years). All participants underwent SD-OCT and 10-2 visual field testing. Macular thickness, ganglion cell complex (GCC), and retinal nerve fiber layer (RNFL) parameters were compared, and correlations with hydroxychloroquine treatment characteristics were analyzed. RESULTS: Macular thickness was significantly reduced in patients with longer hydroxychloroquine exposure, particularly in the parafoveal and perifoveal regions (mean parafoveal thickness: 323.05±12.12μm vs. 311.54±16.09μm; P=0.01). Parafoveal thinning correlated negatively with cumulative dose and treatment duration (r=-0.39, P=0.038 and r=-0.46, P=0.041, respectively). GCC thinning reached statistical significance only in the hemi-inferior quadrant, while RNFL parameters showed no significant differences or correlations. CONCLUSION: Quantitative macular thickness reduction, particularly in the parafoveal region, is associated with hydroxychloroquine exposure and may precede classical structural signs of retinal toxicity. Macular thickness mapping by SD-OCT should be interpreted as a complementary early screening tool rather than a diagnostic criterion for established hydroxychloroquine maculopathy.
Corneal neovascularization (CNV) is a frequent complication of many ocular surface diseases and represents a major threat to corneal transparency, visual function, and corneal graft survival. Accurate characterization, l...Corneal neovascularization (CNV) is a frequent complication of many ocular surface diseases and represents a major threat to corneal transparency, visual function, and corneal graft survival. Accurate characterization, longitudinal monitoring, and assessment of treatment response require reliable and reproducible documentation. Numerous imaging modalities have been investigated for this purpose. Recent quantitative approaches incorporate morphometric parameters, the calculation of which has been facilitated by semi-automated or fully automated segmentation methods, increasingly supported by artificial intelligence. Slit-lamp photography remains the most widely accessible modality for CNV follow-up; however, its reliability and reproducibility are highly dependent on acquisition conditions. Anterior segment angiography using fluorescein and/or indocyanine green enables detailed anatomical analysis, but its invasive nature and technical complexity limit its routine clinical use. Optical coherence tomography angiography (OCT-A) represents a non-invasive alternative that allows three-dimensional visualization and quantitative analysis of CNV, with good correlation to conventional angiographic techniques. Nevertheless, current OCT-A systems are limited by a restricted field of view and the need for post-acquisition processing. Wide-field or full-field imaging systems facilitate acquisition and analysis and appear particularly promising. Similarly, infrared imaging, which is rapid and widely accessible, may contribute to improved standardization and automated image processing in the evaluation of CNV.
Lazreg S, Derdour A, Acheli A
… +9 more, Boudedja H, Garout R, Aberkane J, Cherfi F, Boulaneb-Beddiar F, Mouhoubi A, Zine El Abidine N, Amrit S, Nebab R
INTRODUCTION: The long-term use of pressure-lowering topical medications to treat glaucoma is frequently associated with deleterious effects on the ocular surface. Ocular surface disease (OSD) often remains overlooked an...INTRODUCTION: The long-term use of pressure-lowering topical medications to treat glaucoma is frequently associated with deleterious effects on the ocular surface. Ocular surface disease (OSD) often remains overlooked and untreated in patients with glaucoma and/or ocular hypertension. This study aims to determine the prevalence of OSD in Algeria and to identify risk factors. METHODS: A cross-sectional, descriptive study was conducted in 9 public and private clinical centers and included 544 patients followed for glaucoma and/or ocular hypertension. Individual historical and demographic data, as well as characteristics and management of the patients' glaucoma were collected between October 2023 and February 2024. OSD was evaluated using standard clinical tests. RESULTS: Objective signs of OSD were found in 387 patients (71.3%), and the most frequent form of OSD was dry eye disease (56.6% of all OSDs). Compared to patients without OSD, patients with OSD were older (P=0.001) and had been diagnosed with glaucoma for a longer period of time (P=0.023). Patients with severe glaucoma, previous glaucoma surgery, auto-immune disease, or diabetes were more likely to have OSD (P<0.05). OSD was also more frequent in patients receiving 3 medications or more (80.6%) compared to patients receiving two (73.9%), or one medication (60.6%, P<0.0001). A total of 75.2% of patients using preserved eye drops had OSD versus 41.3% of patients using preservative-free eye drops (P<0.001). The exposure to preserved eye drops (number of drops per day and number of topical medications) was higher in patients with OSD (P<0.05). Among patients who had interrupted their treatment due to local intolerance (n=87), a large majority (89.7%) had OSD. CONCLUSION: Our results confirm the high prevalence of OSD in Algerian patients with glaucoma and/or ocular hypertension. Several risk factors, such as exposure to preserved eye drops, were associated with a higher prevalence of OSD. Management of glaucoma patients should include regular, systematic examination of the ocular surface and can be optimized by switching to preservative-free eye drops if possible or by reducing the number and concentration of medications.