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G Coscas

Publications and source records attributed to G Coscas.

At least 37 records · Page 2Linked to original sources
PubMed2002

[Severe thyroid ophthalmopathy related to interferon alpha therapy].

The authors report a case of a 49-year-old patient presenting with dysthyroid ophthalmopathy, who was treated with interferon alpha for chronic hepatitis C. Proptosis appeared 3 months after treatment onset and many complications occurred over more than 1 year. The extreme severity seen in this case is infrequent. After a summary of other ocular damage linked to interferon, the authors suggest that every interferon treatment include a check-up before beginning therapy and regular biological and ophthalmological monitoring.

Female↗
PubMed2002

[Progression of choroidal neovascularization after macular translocation in age-related macular degeneration and degenerative myopia].

PURPOSE: To study the progression of choroidal neovascularization (CNV) after macular translocation in age-related macular degeneration (AMD) and degenerative myopia. PATIENTS AND METHODS: The data from 42 consecutive eyes (28 AMD, and 14 degenerative myopia) operated on by limited macular translocation (DeJuan technique), with a follow-up of 6 months or more, were prospectively analyzed. In the AMD group, neovascularization was classic in 54% of eyes and classic and occult in 46% of eyes. Previous laser treatment was applied on extra- or juxtafoveal CNV in 3 eyes. The major outcome measures were visual acuity, fluorescein and indocyanine green angiographies. RESULTS: After translocation, foveal displacement was greater in AMD than in myopic eyes (mean: 1 260 and 812 micro m, respectively). Laser photocoagulation was applied postoperatively onto extra-or juxtafoveal CNV in 26 (93%) AMD eyes and 12 myopic eyes (86%). Mean follow-up was 10 months (range, 6-18 months). Recurrence of CNV occurred in 14 AMD eyes (50%) and 2 myopic eyes (14%) an average of 5.6 months after surgery (range, 1-18 months). Recurrence was more frequent in AMD eyes with preoperative occult CNV (66%) than without (36%). Recurrence reached the new fovea in 69% of cases. Supplementary laser treatment was possible and successful on extra- or juxtafoveal recurrence in 3 eyes. Recurrence was significantly correlated with a poor visual prognosis: eyes without recurrence or with extra- or juxtafoveal recurrence had a final gain in visual acuity of 2.4 lines, eyes with subfoveal recurrence had a loss of 1.3 lines, and eyes with diffuse recurrence had a loss of 4.2 lines. CNV appeared in a new area at a BSS injection site in one eye. Occult CNV seemed to fade relatively within the first postoperative weeks, but were unchanged at the end of follow-up. In one eye, a small polypoidal lesion near the disc noted preoperatively disappeared after surgery. CONCLUSION: Our results suggest that the surgical procedure does not affect the course of classic or occult CNV. The rate of recurrence of CNV after macular translocation seemed similar to that observed after conventional laser treatment for extrafoveal CNV in AMD. Neovascular recurrence is the most frequent postoperative complication and was frequently directed at the new fovea. Despite these complications, macular translocation moves CNV outside of the subfoveolar zone so the eyes can be treated with conventional laser, leading to a favorable outcome at the last follow-up in 57% of cases. Further studies are required to confirm these findings and to define the best criteria for treatment.

Choroid↗
PubMed2002

[Age related macular degeneration: a review of anti-angiogenic treatments].

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.

Adrenal Cortex Hormones↗
PubMed2002

[Photodynamic therapy].

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.

Aging↗
PubMed2002

[Study of internal limiting membrane peeling in stage-3 and -4 idiopathic macular hole surgery].

PURPOSE: To evaluate the advantages of peeling the internal limiting membrane (ILM) in macular hole surgery. PATIENTS AND METHODS: Retrospective analysis of the results of macular hole surgery, comparing two surgical protocols performed by the same surgeon. Both protocols included a standard pars plana vitrectomy with intravitreous nonexpansile gas and adjunction of autologous plasma over the macular hole. In addition, in the second group, the ILM of the eyes was systematically peeled after its coloring by indocyanine green (infracyanine) in the latter patients. RESULTS: We studied 39 eyes of 36 patients with stage-3 or -4 macular hole surgery. The duration of symptoms before surgery was on average 9 months. Twenty-one eyes (53.8%) underwent ILM peeling. Macular hole closure after one procedure was significantly more frequent postoperatively in the group of eyes with ILM peeling than in the other group (90% and 50%, respectively, p<0.01); after two procedures, macular hole closure reached 61% in the second group. The macular hole seemed to have disappeared on angiographic examination and on OCT in 90% of eyes with anatomical success in the group with ILM peeling and in only 22% of eyes with anatomical success in the group without. Visual acuity improved by two lines or more in 62% of eyes with ILM peeling and in 44% of eyes without. The difference in improvement in the macular threshold was statistically significant (p<0.001). CONCLUSION: This study would suggest that peeling of the ILM is an important adjuvant for successful closure of macular holes. Its possible mechanism of action is discussed. Further studies are needed to confirm these data by controlled randomized trial.

Aged↗
PubMed2001

Effect of isovolemic hemodilution in central retinal vein occlusion.

BACKGROUND: Hemorheologic abnormalities have recently been shown to play a role in the pathogenesis of retinal vein occlusion (RVO), and several studies have demonstrated the efficacy of isovolemic hemodilution in these eyes. This study was designed to investigate further the effects of hemodilution, with regard to the duration of symptoms before the treatment. METHODS: In a prospective study, 142 eyes with central or hemicentral RVO were treated by isovolemic hemodilution. The target hematocrit value was 35%. Mean duration of follow-up was 10 months. A subgroup of 50 patients treated within 2 weeks of the onset of symptoms was compared first with patients treated later by hemodilution, and then retrospectively with controls with central RVO and without hemodilution. RESULTS: Hemodilution therapy resulted in a decrease in hematocrit level from 42% to 32% on average, with no major side effect. After treatment, a significant decrease was observed in hemorheologic parameters (fibrinogen, erythrocyte aggregation), except in plasma viscosity. Retinal circulation times were significantly shortened. Visual acuity (VA) improvement immediately after treatment (in 43% of eyes) was correlated with better final visual outcome (P<0.05). At the end of follow-up, VA was better in patients treated within the first 2 weeks than in those treated later and in controls (41% had VA of 20/40 or more in the early-treatment group versus 23% in the late-treatment group, P<0.01). Final retinal ischemia was also greater in the late-treatment group and in controls. Hemodilution in 12 patients with long-standing RVO and macular edema was ineffective. CONCLUSION: Our study is consistent with previous investigations that confirmed the efficacy of isovolemic hemodilution in RVO on hemorheologic parameters, retinal circulation times and final VA. It also underlined strongly the benefit of early treatment within the first 2 weeks of the RVO. Further studies are required to confirm these results.

Adolescent↗
PubMed2001

Translocation of the macula for management of subfoveal choroidal neovascularization: comparison of results in age-related macular degeneration and degenerative myopia.

PURPOSE: To report the results of limited macular translocation in subfoveal choroidal neovascularization resulting from age-related macular degeneration or degenerative myopia. METHODS: The first consecutive 32 patients (23 age-related macular degeneration eyes and nine myopic eyes) were operated on with the limited macular translocation technique described by de Juan. Before and after surgery, a complete examination included fluorescein and indocyanine-green angiographies and optical coherence tomography. Mean follow-up was 9 months in the age-related macular degeneration group (range, 6 to 14 months) and 10 months in the myopic group (range, 6 to 15 months). RESULTS: The improvement in visual acuity was better in the myopic group than in the age-related macular degeneration group and was correlated with younger age in the myopic group (P <.05). At the end of follow-up, visual acuity improved by 2 lines or more in seven age-related macular degeneration eyes (30%), including four eyes (13%) with an improvement of 6 lines or more, and in six myopic eyes (67%), including two eyes (22%) with an improvement of 6 lines or more. Final visual acuity was unchanged in four age-related macular degeneration eyes (17%) and three myopic eyes (33%), and decreased in 12 age-related macular degeneration eyes (52%). Conversely, the mean foveal displacement was greater in age-related macular degeneration than in myopia (1,105 microm and 685 microm, respectively; P <.05). Main complications were retinal detachment (six eyes), neovascularization at the injection site (two eyes), and recurrence of neovascularization (43% of the age-related macular degeneration group and 11% of the myopic group). CONCLUSIONS: Limited macular translocation allowed a significant improvement in visual acuity in some eyes with subfoveal neovascularization and resulted in a moderate rate of complications. Longer follow-up and additional studies are required to confirm these findings.

Adult↗
PubMed2001

A new approach of geodesic reconstruction for drusen segmentation in eye fundus images.

Segmentation of bright blobs in an image is an important problem in computer vision and particularly in biomedical imaging. In retinal angiography, segmentation of drusen, a yellowish deposit located on the retina, is a serious challenge in proper diagnosis and prevention of further complications. Drusen extraction using classic segmentation methods does not lead to good results. We present a new segmentation method based on new transformations we introduced in mathematical morphology. It is based on the search for a new class of regional maxima components of the image. These maxima correspond to the regions inside the drusen. We present experimental results for drusen extraction using images containing examples having different types and shapes of drusen. We also apply our segmentation technique to two important cases of dynamic sequences of drusen images. The first case is for tracking the average gray level of a particular drusen in a sequence of angiographic images during a fluorescein exam. The second case is for registration and matching of two angiographic images from widely spaced exams in order to characterize the evolution of drusen.

Fluorescein Angiography↗
PubMed2001

[Choroidal neovascularization as a complication following laser treatment of central serous chorioretinopathy].

We report the case of a 39-year old man who presented with central serous chorioretinopathy. Two months after diagnosis, argon laser photocoagulation was performed. One month later, the patient noticed distortion and a reduction in vision revealing a subretinal neovascularization above the fovea next to the laser scar. The patient underwent surgical extraction of the neovascular membrane and recovered a visual acuity of 20/30. This case report shows a complication of laser treatment of central serous chorioretinopathy and underlines the diagnostic difficulties of this disease and its treatment modalities. The surgical excision, the first reported in this etiology, led to good visual recovery, as is usually observed in young patients operated on for neovascular membrane.

Adult↗
PubMed2001

[New therapies for the treatment of age-related macular degeneration].

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.

Aged↗
PubMed2001

[Optical coherence tomography in the follow up of macular edema treatment in retinitis pigmentosa].

Macular edema is frequently responsible for loss of central vision in patients affected with retinitis pigmentosa (RP). This macular edema can be treated with acetazolamide. Our purpose was to evaluate optical coherence tomography (OCT) examination in the follow-up of macular edema in RP. In addition, we tried to evaluate the minimal efficient dose of acetazolamide, using means other than fundus examination or fluorescein angiography. We report the cases of 5 patients affected with typical retinitis pigmentosa and fundus appearance of macular edema. These patients received oral acetazolamide treatment (500 mg/d). The OCT examinations were performed before and during treatment, which allowed us to demonstrate, quantify and monitor the progression of macular edema during treatment. OCT appears to be a useful tool in the follow-up of patients affected with macular edema and RP. This noninvasive examination contributes to improving our strategy in treating patients.

Adult↗
PubMed2001

[Age-related macular degeneration and genetics].

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.

Humans↗
PubMed2000

Treatment of recent onset central retinal vein occlusion with intravitreal tissue plasminogen activator: a pilot study.

AIMS: To study the effects of intravitreal tissue plasminogen activator (tPA) in recent onset central retinal vein occlusion (CRVO). METHODS: 15 patients with recent onset CRVO (from 1-21 days' duration, mean 8 days) were given 75-100 microg of tPA intravitreally associate with low dose low molecular weight heparin. CRVO was perfused in nine patients and with mild ischaemia not exceeding 100 disc diameters in six patients. Follow up ranged from 5 to 21 months for 14 patients (mean 8 months). Visual acuity measurement, macular threshold (Humphrey perimeter), fluorescein angiography with the scanning laser ophthalmoscope with special emphasis on retinal circulation times, and retinal perfusion were performed at days 0, 1, and 8 and months 1, 3, and 6. RESULTS: Visual acuity was significantly improved on the first day after treatment in only one eye, and decreased transiently in six eyes (40%). Retinal blood velocity was not significantly modified by tPA injection. Retinal ischaemia developed in six eyes (43%), leading to panretinal photocoagulation in five eyes including one with rubeosis iridis. At the end of follow up, visual acuity had improved to 20/30 or better in five eyes (36%), including two with complete recovery; visual acuity was worse than 20/200 in three eyes (28%). No complication of tPA injection was observed. CONCLUSION: Intravitreal tPA treatment for CRVO appears to be simple and safe, but did not significantly modify the course of the occlusion in our patients immediately after treatment. Final visual outcome did not differ significantly from that observed in the natural course of the disease, but final visual acuity seemed to be slightly better. A randomised study is required to determine if intravitreal tPA actually improves visual outcome in CRVO.

Aged↗
PubMed2000

ABCR gene analysis in familial exudative age-related macular degeneration.

PURPOSE: Identification of genetic factors in the pathogenesis of age-related macular degeneration (AMD) is of crucial importance in this common cause of blindness. Mutations in the Stargardt disease gene (ABCR) were previously reported in patients with atrophic forms of AMD. The purpose of this study was to analyze familial segregation of ABCR gene mutations in 52 unrelated multiplex cases of exudative AMD. METHODS: A complete ophthalmological examination including visual acuity measurement, fundus examination, and fluorescein angiography (FA) was performed on each exudative AMD patient. The entire coding sequence of the ABCR gene was analyzed using a combination of single-strand conformation polymorphism and confirmatory sequencing of the exons showing an abnormal pattern of migration. RESULTS: Six heterozygous missense changes were identified. A lack of familial segregation was observed in 4 of 6 codon changes (Arg943Gln, Val1433Ile, Pro1948Leu, and Ser2255Ile). Conversely, 2 codon changes cosegregated with the disease in 2 small families: Pro940Arg and Leu1970Phe. CONCLUSIONS: The authors believe that segregation of the ABCR gene mutations with familial cases of AMD has not yet been shown. The analysis of familial segregation allowed the authors to exclude 4 of 6 codon changes as disease-causing mutations. Furthermore, it was shown here that the ABCR gene may be rarely involved in exudative AMD, with at best 2 of 52 familial cases (4%) related to this susceptibility factor.

ATP-Binding Cassette Transporters↗
PubMed2000

Multiple choroidal neovascularizations at the border of a myopic posterior macular staphyloma.

BACKGROUND: In pathologic myopia, choroidal neovascularization (CNV) usually occurs in macular region and at the center of the macular staphyloma. CNV has been reported to occur at the borders of an inferior posterior staphyloma in the tilted disc syndrome. We present a case of multiple simultaneous CNVs located at the borders of a myopic macular staphyloma. METHODS: The clinical and angiographic records of a myopic patient who presented several areas of choroidal neovascularization were reviewed. RESULTS: On fundus examination, four gray lesions surrounded by subretinal hemorrhages and covered by a large serous retinal detachment were observed at the borders of a posterior staphyloma. Fluorescein angiography revealed that these four lesions were CNVs extending from the borders of the staphyloma to the macular region. As measured by B-scan ultrasonography, the staphyloma was 4 mm deep. CONCLUSION: This case supports the hypothesis that the borders of staphylomas are sites at risk for the development of CNV in pathologic myopia.

Choroidal Neovascularization↗
PubMed2000

[B-scan ultrasonography and optical coherence tomography (O.C.T.) in epiretinal macular membranes: pre- and post-operative evaluation].

PURPOSE: This study was designed to evaluate B-scan ultrasonography and optical coherence tomography in the pre- and post-operative morphologic evaluation of idiopathic epiretinal macular membranes. METHODS: Fifteen eyes were examined using B-scan ultrasonography and optical coherence tomography before and after surgical excision of the epiretinal macular membranes. RESULTS: Ultrasonography prior to surgery allowed an excellent evaluation of both the peripheral and the posterior vitreous and showed the membrane. The thickening of the retina and the retinal folds were equally visualised by either method. An improved observation of the macular oedema was obtained by the optical coherence tomography as well as the type of membrane adhesion. After surgery, both methods were able to detect membrane remnants. A better visualisation of retinal thickness and cystoid macular oedema was obtained by optical coherence tomography rather than ultrasonography. Serous sub-foveal retinal detachment was only revealed by optical coherence tomography. DISCUSSION: Ultrasonography is indispensable in case of media opacity or of optical inaccessibility of the posterior pole. Moreover, it allows an excellent global analysis of the anterior and posterior vitreous, which is very useful for the surgeon. The membrane is always showed by ultrasonography, but not always by optical coherence tomography in case of diffuse adherence. Both methods can detect the membrane and a cystoid macular edema. However, retinal analysis with the optical coherence tomography is more precise. It can even detect cysts of the macular oedema or serous sub-foveal retinal detachment. CONCLUSION: B-scan ultrasonography and optical coherence tomography give complementary information in pre- and post-operative examination of epiretinal macular membranes.

Epiretinal Membrane↗