Neuromyelitis optica is a rare inflammatory demyelinating disorder of the central nervous system, most often associated with aquaporin-4 (AQP4) antibodies and, less frequently, with myelin oligodendrocyte glycoprotein (M...Neuromyelitis optica is a rare inflammatory demyelinating disorder of the central nervous system, most often associated with aquaporin-4 (AQP4) antibodies and, less frequently, with myelin oligodendrocyte glycoprotein (MOG) antibodies. AQP4-positive disease is considered an autoimmune astrocytopathy, whereas MOG-positive disease represents an oligodendrocytopathy. Although these entities have distinct pathophysiological mechanisms, rare cases of double AQP4/MOG positivity have been reported, raising specific diagnostic, prognostic, and therapeutic issues. We report the case of a 48-year-old woman admitted with severe left optic neuritis and contralateral hypesthesia. Orbital MRI revealed anterior involvement of the left optic nerve with perineuritis along with bilateral chiasmal lesions. Spinal MRI demonstrated a focal cervical lesion consistent with transverse myelitis. Both AQP4 and MOG antibodies were positive in the serum and cerebrospinal fluid. Plasma exchange combined with intravenous corticosteroids led to partial improvement, but the patient experienced an early relapse on oral steroids, resulting in severe visual loss despite initiation of rituximab. Double-positive cases remain rare and clinically heterogeneous. Our observation is notable for the simultaneous occurrence of anterior, chiasmal, and spinal cord lesions at the onset of the disease. The concordance between serological profiles and MRI features typical of each entity supports the concept of dual pathogenicity. This case underlines the importance of systematic testing for both AQP4 and MOG antibodies in severe, bilateral, or atypical optic neuritis and supports the need for early immunosuppressive treatment to limit visual sequelae.
Heintz V, Bastelica P, Baudouin C
… +13 more, Rousseau A, Labetoulle M, Bodaghi B, Debillon L, Vest A, Chami Y, Lecannuet A, Bouvet M, Lama H, Bistour A, Brézin A, Labbé A, Lachkar Y
PURPOSE: This study aimed to evaluate the one-year efficacy and safety of the PAUL® Glaucoma Implant with ripcord for treating refractory glaucoma. METHODS: Conducted between November 2021 and September 2023 across five...PURPOSE: This study aimed to evaluate the one-year efficacy and safety of the PAUL® Glaucoma Implant with ripcord for treating refractory glaucoma. METHODS: Conducted between November 2021 and September 2023 across five hospitals in Île-de-France, France, the study included patients with refractory glaucoma who underwent stand-alone implantation of the PAUL® Glaucoma Implant with a ripcord technique. Two success criteria were assessed at 12 months: (1) complete success: intraocular pressure (IOP)≤21mmHg with a≥20% reduction in IOP without IOP-lowering medications, no additional filtering surgery, no chronic hypotony, defined as an IOP≤5mmHg measured at two successive visits 3 months apart, and no loss of light perception; (2) qualified success: same criteria as complete success but with the same or fewer IOP-lowering medications. RESULTS: The study evaluated 41 eyes of 41 patients, all of whom had undergone at least one previous glaucoma surgery (mean 1.7 surgeries per patient) and a mean visual field deviation of -15.7dB. At 12 months, 39.0% of patients achieved complete success; 97.6% achieved qualified success. No additional filtering surgeries were required. The mean IOP decreased significantly from 28.7mmHg to 12.6mmHg (-53.0%, P<0.0001), and the mean number of IOP-lowering medications decreased from 3.9 to 1.2 (-69.4%, P<0.0001). Complications included transient hypotony in one patient (2.4%), spontaneously resolving choroidal detachment in seven patients (17.1%), tube exposure in one patient (2.4%), and diffuse corneal edema in two patients (4.9%). CONCLUSION: The PAUL® Glaucoma Implant with ripcord appears safe and effective, reducing the risk of early postoperative hypotony and allowing further minimally invasive IOP-lowering during follow-up.
PURPOSE: To investigate early optic nerve damage by analyzing visual evoked potentials (VEP) before and after proton beam radiation therapy. METHODS: Seventy-one adult patients (142 eyes) who received proton beam radiati...PURPOSE: To investigate early optic nerve damage by analyzing visual evoked potentials (VEP) before and after proton beam radiation therapy. METHODS: Seventy-one adult patients (142 eyes) who received proton beam radiation therapy and underwent ophthalmological assessments including VEP, optical coherence tomography (OCT) and visual field perimetry at baseline and 6, 12, and 18 months post-treatment were included in this bicentric prospective study. RESULTS: The median age was 63.1 years, with female predominance (63.1%). Tumors included meningiomas (43.7%, n=31), pituitary adenomas (19.7%, n=14), and nasal sinus or cutaneous carcinomas (12.7%, n=9). Baseline VEP values were below normal: pattern 60' peak time=112ms for 6.55mV, pattern 30'=115ms for 7mV, pattern 15'=123ms for 6.05mV. Abnormal VEP values were observed in 78% of patients prior to radiation therapy. Peak time increased significantly at each of the follow up visits for Pa60' and Pa30', peaking at 18 months post-treatment (+6ms, P<0.01). Amplitudes showed a non-significant downward trend, peaking at 18 months. VEP peak time and amplitudes did not correlate with other visual outcome measures (ETDRS acuity, OCT RNFL thickness, or perimetry). CONCLUSION: VEPs may serve as an early, non-invasive indicator of radiation-induced optic neuropathy (RION) and should be considered in multidisciplinary monitoring protocols for patients undergoing proton beam radiation therapy.
PURPOSE: To evaluate clinical outcomes after implantation of new presbyopia-correcting intraocular lens (IOL): Artis Symbiose® (Cristalens Industrie, France). SETTING: Tertiary referral center, Brest, France. DESIGN: Non...PURPOSE: To evaluate clinical outcomes after implantation of new presbyopia-correcting intraocular lens (IOL): Artis Symbiose® (Cristalens Industrie, France). SETTING: Tertiary referral center, Brest, France. DESIGN: Non-comparative prospective interventional study. METHODS: Patients undergoing bilateral IOL implantation were included. Visual acuity (VA) for distance, intermediate (70cm) and near (40cm) vision were measured. In addition, defocus curves were obtained at 1 and 6months, and a reading speed test was assessed using the Salzburg Reading Desk® (SRD) 3months after surgery. The VF-14 questionnaire was evaluated at 1, 3 and 6months after surgery to measure spectacle independence, and a level of satisfaction questionnaire was completed at the 6-month follow-up visit. RESULTS: The study included 48 eyes. Mean postoperative monocular uncorrected VA, for MID and PLUS respectively, was 0.028±0.08 LogMAR and 0.057±0.10 at distance (UDVA), 0.035±0.10 and 0.037±0.09 at intermediate (UIVA), 0.078±0.11 and 0.030±0.10 at near (UNVA). Binocularly, uncorrected VA was -0.022±0.02 at distance, -0.002 at intermediate, and 0.015 at near. The binocular defocus curve at 6months after surgery was above 0 LogMAR between +0.50 D and -2.50 D. The mean satisfaction rate at 6months was 83%. CONCLUSION: The Artis Symbiose® IOL provides functional uncorrected visual acuity at distance, intermediate and near positions, without the need for additional optical aid. It is an effective option in active presbyopic patients, with a continuous and extended depth-of-focus, providing added value compared to trifocal implants.
We present a case of orbital recurrence of choroidal melanoma 14years post-evisceration. Initially misdiagnosed as trauma-related, the patient's condition progressed, leading to neovascular glaucoma and retinal detachmen...We present a case of orbital recurrence of choroidal melanoma 14years post-evisceration. Initially misdiagnosed as trauma-related, the patient's condition progressed, leading to neovascular glaucoma and retinal detachment. Subsequent pain and complications prompted evisceration without a pathological evaluation. Fourteen years later, an orbital mass was identified, leading to an orbital exenteration. This case demonstrates the potential for long-term local-regional recurrence of choroidal melanoma and highlights the importance of thorough examination and pathological evaluation in cases of a painful, sightless eye to prevent delayed diagnoses and improve patient outcomes.
BACKGROUND/PURPOSE: Doppler holography is a new technique of non-invasive imaging that allows observation of blood flow in retinal vessels. The goal of the present study was to determine if intraocular pressure (IOP) has...BACKGROUND/PURPOSE: Doppler holography is a new technique of non-invasive imaging that allows observation of blood flow in retinal vessels. The goal of the present study was to determine if intraocular pressure (IOP) has an effect on the calculation of optic nerve head blood flow using Doppler holography in patients with primary open-angle glaucoma (POAG). SUBJECTS AND METHODS: Four patients with POAG or ocular hypertension greater than or equal to 30mmHg were enrolled. The velocity of blood flow in the first branch of the central retinal artery (CRA) was measured before and after surgical lowering of the IOP. The measurements were performed by Doppler holography. Peak systolic velocity (PSV), end diastolic velocity (EDV), resistivity index (RI), and area under the velocity curve (AUC) were calculated for each patient and compared. RESULTS: Four patients were included in the analysis. The median age was 75.5 years (67-84). The glaucoma was staged as severe in half of the patients. Acquisitions were performed between 1 and 14 days after surgery. A median postoperative decrease in IOP of 23mmHg (20-25.5) was associated with an improvement in diastolic CRA flow [EDV significatively increased (P=0.029)], and RI significatively decreased (P=0.029). Conversely, AUC and PSV did not change significantly. CONCLUSIONS: Reducing IOP in patients with POAG significantly improved diastolic CRA flow, while systolic flow did not appear to change. This pilot study confirms that Doppler holography can precisely measure CRA blood flow.
PURPOSE: To evaluate changes over a 10-year period in the iridocorneal angle following implantable collamer lens (ICL) implantation. METHODS: This retrospective study included 48 eyes of 24 patients who underwent ICL imp...PURPOSE: To evaluate changes over a 10-year period in the iridocorneal angle following implantable collamer lens (ICL) implantation. METHODS: This retrospective study included 48 eyes of 24 patients who underwent ICL implantation. Trabecular-iris angle (TIA), trabecular-iris space area (TISA), and angle opening distance (AOD) at 500μm from the scleral spur, along with vault distance, were measured using Fourier-domain anterior segment optical coherence tomography (AS-OCT). Primary endpoints were changes in TIA, TISA, and AOD from baseline to year 10. Secondary outcomes included changes in vault and predictors of anterior chamber angle opening. RESULTS: Forty-eight eyes of 24 patients were included in the study. The mean spherical equivalent was -9.1±3.9 diopters, with 60.4% of eyes receiving a spherical ICL and 39.6% a toric ICL. Significant reductions in nasal and temporal TIA (P<0.001) were observed at month 1, stabilizing over 10 years. Similar patterns were found for TISA and AOD. The vault demonstrated a gradual decrease over time. Multiple regression analysis revealed that preoperative TIA and postoperative vault at 1 month were significantly associated with TIA at both 1 month (P<0.0001, P=0.0050, P=0.0080, and P=0.0191, respectively) and 10 years postoperatively (P=0.0011, P=0.0016, P=0.0128, and P=0.0293, respectively) in the nasal and temporal quadrants. CONCLUSION: ICL implantation provides long-term stability in the iridocorneal angle opening, with preoperative angle measurements serving as key predictors of long-term outcomes. This stability was maintained even after a decade, highlighting the procedure's durability in terms of anterior segment configuration.
INTRODUCTION: Sickle cell disease is an autosomal recessive genetic disorder caused by a mutation of the β-globin gene. Sickle cell retinopathy is a common complication of sickle cell disease. PATIENTS AND METHODS: We co...INTRODUCTION: Sickle cell disease is an autosomal recessive genetic disorder caused by a mutation of the β-globin gene. Sickle cell retinopathy is a common complication of sickle cell disease. PATIENTS AND METHODS: We conducted a multicenter, cross-sectional, descriptive study with both retrospective and prospective data collection between January 2020 and January 2023, including patients with sickle cell retinopathy. RESULTS: A total of 274 patients were examined, including 148 men and 126 women, aged 9 to 80 years, with a mean age of 33.38 years. Among the 274 patients, 272 had major sickle cell syndromes (261SC, 8SS, and 3S/β-thalassemia). The main fundus lesions observed were "sea fan" neovascularization (33.2%) and arteriovenous anastomoses (28.4%). On fluorescein angiography, Goldberg stage III predominated, with a frequency of 37.2% in the right eye and 36.5% in the left eye. Of the 271 cases of sickle cell retinopathy, the proliferative form was found in 92.7% of patients, while the non-proliferative form accounted for 6.3%. The most frequently performed treatment was argon laser photocoagulation (44.5%). One case of anti-VEGF injection combined with argon laser panretinal photocoagulation resulted in a visual gain of two lines. CONCLUSION: Proliferative sickle cell retinopathy represents a serious complication in the course of sickle cell disease. Early detection and treatment with argon laser photocoagulation remains the cornerstone of preventing sight-threatening complications. Anti-VEGF therapy is useful in the prevention and management of vitreous hemorrhages.