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Biomedical subjects

G Soubrane

Publications and source records attributed to G Soubrane.

At least 73 records · Page 4Linked to original sources
PubMed1999

[Ocular complications of hormonal treatments: oral contraception and menopausal hormonal replacement therapy].

Numerous reports have described ocular complications of sex hormone preparations, particularly after the appearance of the oral contraceptive pill. The most serious complications are vascular occlusions such as central retinal vein or artery occlusion and acute ischemic optic neuropathy. In these cases, permanent visual loss may occur. Combined oral contraceptives have been reported to increase the incidence of these complications but it remains very low. It seems to lessen with the decrease in the estrogen dosage and the use of third-generation progestins. Conversely, post-menopausal hormone replacement therapy seems to have a protective effect for retinal vascular complications. Other ocular involvements have been described with sex hormone preparations but remain not yet confirmed, such as the effect on cataract, lacrymal secretion, diabetic retinopathy, age-related macular degeneration.

Cataract↗
PubMed1999

A novel ABCR nonsense mutation responsible for late-onset fundus flavimaculatus.

PURPOSE: To report the ophthalmologic features of a novel truncating mutation in the ABCR gene in a patient affected with late-onset fundus flavimaculatus (FFM). METHODS: A complete ophthalmologic examination was performed in a 70-year-old patient, including best-corrected visual acuity measurement, slit lamp and fundus examination, fundus photographs, frequent fluorescein and indocyanine green angiographies, visual field testing, color vision analysis, electroretinogram, and electro-oculogram. The 50 exons of the ABCR gene were analyzed using direct sequencing. RESULTS: Fluorescein and indocyanine green angiographies confirmed the diagnosis of FFM. A heterozygous base change was found, resulting in the substitution of an arginine to a stop at codon 152 of the ABCR gene. CONCLUSIONS: A heterozygous nonsense ABCR gene mutation was found in a patient affected with FFM. No other mutation has been identified in the entire coding sequence and the promoter region, suggesting that a heterozygous severe ABCR mutant may be responsible for a mild and delayed FFM phenotype, different from that of age-related macular degeneration.

ATP-Binding Cassette Transporters↗
PubMed1999

[Sarcoid optic neuropathy].

Sarcoidosis is a multisystem granulomatous disease mostly involving the chest. Sarcoid optic neuropathy is an uncommon but serious manifestation that requires long-term corticosteroid treatment. We report here the case of a 50-year-old black patient complaining of a recent blurred vision on his left eye. The ophthalmologic examination was normal. Goldmann visual field and visual evoked potentials confirmed the diagnosis of retrobulbar optic neuropathy. Sarcoidosis was presumed on a chest radiography and computed tomography and confirmed with a transbronchial biopsy. Symptoms disappeared with intravenous bolus of corticosteroids. Three months later, without treatment, a right inferior eyelid tumor was observed. Magnetic resonance imaging (RMI) showed two orbital masses and multiple meningeal lesions enhancing with contrast suggesting neurosarcoidosis which decreased with a long-term high-dose corticosteroid therapy (1 mg/kg/d). Optic neuropathy is a rare manifestation of neurosarcoidosis, mostly accompanied by optic-disc involvement with papillary lesions. Chest roentgenogram and computed tomography give a presumption of sarcoidosis. But biopsy is mandatory to confirm the diagnosis demonstrating the histologic lesion of a non caseating granulomatous. Corticosteroid therapy is dramatically efficient but sometimes several months treatment is required.

Black People↗
PubMed1998

The epsilon4 allele of the apolipoprotein E gene as a potential protective factor for exudative age-related macular degeneration.

PURPOSE: Apolipoprotein E (ApoE) is a polymorphic protein that plays a central part in plasma metabolism of lipids and in central nervous system lipid homeostasis. Our purpose was to evaluate the potential role of ApoE polymorphism in the occurrence of exudative age-related macular degeneration associated with drusen, which contain lipids. METHODS: We analyzed apolipoprotein E genotypes in 116 unrelated patients with exudative age-related macular degeneration in one eye and hard drusen (n = 39) or soft drusen (n = 77) in the other eye, and compared the results with those of age-matched and sex-matched control subjects (n = 168). Apolipoprotein E alleles were detected by a ploymerase chain reaction-based method. RESULTS: A lower frequency of the epsilon4 allele carriers was observed in the exudative age-related macular degeneration group compared with control subjects (12.1% vs 28.6%, respectively; P < .0009). The epsilon4 allele was less frequent in the age-related macular degeneration group compared with control subjects (0.073 vs 0.149, respectively; P < .006). This decreased frequency of the epsilon4 allele was mainly observed in the soft drusen subgroup compared with control subjects (0.045 vs 0.149, respectively; P < .0009). CONCLUSION: This lower relative frequency of the epsilon4 allele supports the hypothesis that the ApoE gene is a genetic protective factor identified in age-related macular degeneration.

Aged↗
PubMed1998

Macular dystrophy, diabetes, and deafness associated with a large mitochondrial DNA deletion.

PURPOSE: To report the mitochondrial DNA in a 17-year-old patient with diabetes, deafness, cataract, and maculopathy. METHOD S: Ophthalmologic examination, fluorescein angiography, and electroretinogram were performed. Detection of deletion was analyzed by polymerase chain reaction and Southern blot, and screening for the A3243G mitochondrial DNA mutation was performed. RESULTS: A short fragment of approximately 8.5 kb corresponding to deleted mitochondrial DNA was detected. The A3243G mitochondrial DNA mutation was not found. CONCLUSIONS: A 7-kb heteroplasmic deletion of the mitochondrial genome was found in this patient. No mitochondrial DNA deletion has been reported previously in association with macular dystrophy.

Adolescent↗
PubMed1998

Exclusion of the apoE gene in autosomal dominant retinitis pigmentosa.

Our purpose was to search for mutations in the apolipoprotein E (apoE) gene and to evaluate the role of apoE polymorphisms in the occurrence of autosomal dominant retinitis pigmentosa (ADRP). The ApoE gene coding sequence was analyzed in 51 unrelated patients affected with ADRP. A screening for mutations by SSCP and an analysis of the apoE polymorphisms were performed using PCR and restriction enzymatic digestion. No abnormal patterns of migration were observed by SSCP analysis. No significant statistical difference was seen between our ADRP population and the French general population for apoE allele frequency. From these results we report that the apoE gene does not seems to be involved in our ADRP population.

Apolipoproteins E↗
PubMed1998

[Radiotherapy of occult neovascularization in senile macular degeneration: initial results of a pilot study].

BACKGROUND: AMD is the leading cause of legal blindness in people aged of more than 50 in industrialized countries. Occult neovascularization accounts for more than 70% of all exsudatives forms of AMD. Radiotherapy has been proposed as a possible treatment for retrofoveal neovascularization. We present the first results of a pilot study actually ongoing at the AMD Center in Creteil. PATIENTS AND METHODS: 44 patients (46 eyes) presenting occult choroidal neovascularization involving the fovea, aged of > 50 years and with a minimal visual acuity of at least 0.1 were included. They received a total dose of 16 Gy in 4 sessions of 4 Gy. All the patients were checked after 3 months. RESULTS: Visual acuity was globally maintained (> 0.1 in 93% of the eyes). Only one eye suffered a significant loss of vision (> 6 lines) and 11% suffered a moderate loss of vision (> 3 lines). Moreover 67% of eyes still had a near vision of 0.5 or more with reading glasses. On fluorescein angiography 17.5% of the eyes experienced an increase of the size of the occult neovascularization of > 0.5 Disk Area (DA), 76% showed no modification and 6.5% demonstrated a decrease in size of > 0.5 DA. CONCLUSIONS: As it has been shown that the antimitotic action of radiotherapy is most effective after 3 months, the present results suggest better evolution than natural history. However, as occult choroidal neovascularization is a slow-evolving disease further follow-up is needed to confirm it.

Aged↗
PubMed1998

Case-control study of the risk factors for age related macular degeneration. France-DMLA Study Group.

AIM: A case-control study was initiated to determine the risk factors for the development of age related macular degeneration (AMD). METHODS: Study participants, who were all white, aged 50-85 years, and were recruited from private ophthalmology practices. Each practitioner enrolled patients with bilateral AMD, who were then matched with controls for sex and age. Environmental factors and systemic and ocular histories were screened. All patients had bilateral red-free fundus photographs and fluorescein angiography. Photographs were classified into pigment epithelium alterations, drusen, geographic atrophy, and exudative AMD. Statistical analysis included the identification of risk factors for AMD. A multivariate analysis was performed at the end of the study. Analysis included the entire study population and was carried out for each stage of AMD. RESULTS: 1844 controls were compared with 1844 patients with AMD. Mean age was 71 years for controls and 72 for cases. Logistic regression identified six major risk factors for AMD (whole population): arterial hypertension (odds ratio (OR) = 1.28), coronary disease (OR = 1.31), hyperopia (OR = 1.33), light coloured irises (OR = 1.22), and lens opacities or previous cataract surgery (OR = 1.55). The significance of vascular risk factors was increased for late stages of AMD, especially the atrophic forms (coronary disease, OR = 3.19). CONCLUSIONS: This large case-control study confirms some of the risk factors previously identified and may contribute to the determination of methods for prevention of AMD.

Age Distribution↗
PubMed1998

[Indocyanine green angiography of basal laminar drusen in the retinal pigment epithelium associated with vitelliform macular degeneration].

PURPOSE: In the mid-late life, basal laminar drusen can be associated with vitelliform macular degeneration and choroidal neovascularization. The differential diagnosis between these two clinical entities is not always easy with fluorescein angiography. The aim of this case report is to describe the indocyanine green angiographic features of basal laminar drusen and pseudo-vitelliform material and to evaluate the role of ICG angiography in differentiating new choroidal vessels from vitelliform macular degeneration. PATIENTS AND METHODS: Six patients (12 eyes) with central visual loss and metamorphopsia underwent a biomicroscopic examination. Diagnosis was basal laminar drusen and bilateral vitelliform macular degeneration. Fluorescein and indocyanine green angiographies were performed and the results were compared. RESULTS: In all eyes, basal laminar drusen were hyperfluorescent with both angiographies. On fluorescein angiography, the macular material was hypofluorescent early, but gradual staining occurred from the borders in the late phase. In 8 out of the 12 eyes, fluorescein angiographic characteristics of the macular lesions could not provide clues to differential diagnostic between new choroidal vessels and vitelliform material. On indocyanine green angiography, in 8 eyes the material remained intensely hypofluorescent during the whole sequence. In 4 eyes, indocyanine green angiography allowed the identification of hyperfluorescent well-defined new choroidal vessels. CONCLUSIONS: Indocyanine green angiography allows the visualization of basal laminar drusen and can easily differentiate choroidal neovascularization from acquired vitelliform degeneration.

Angiography↗
PubMed1998

[Retinal vein occlusion and lipoprotein (a)].

PURPOSE: Epidemiological studies have shown a significant correlation between increased levels of lipoprotein (a) and coronary and cerebral vascular diseases. Lipoprotein (a) presents a striking homology with plasminogen and may therefore complete with binding of plasminogen at fibrin and at the endothelial cell surface, leading to fibrinolytic system dysfunction. The aim of this work is to study the relationship between increased levels of Lp(a) and retinal vein occlusion. METHODS: 132 consecutive patients with retinal vein occlusion were screened for lipoprotein (a) level. They also underwent initial and final visual acuity measurement, fluorescein angiography and blood tests including glucose, cholesterol and triglyceride levels, apolipoprotein A1 and B, protein electrophoresis, coagulation tests. Lipoprotein (a) results were compared with those of 52 age, sex and cardiovascular risk factors-matched controls. RESULTS: Lipoprotein (a) values were significantly higher in the retinal vein occlusion group than in the control group (p = 0.05). Elevated lipoprotein (a) (> 0.1 g/l) levels were observed more often in retinal vein occlusion patients (61%) than in the controls (42%; p < 0.02). No correlation was found in retinal vein occlusion patients between high levels of lipoprotein (a) and a severe form of retinal vein occlusion. Lipoprotein (a) levels were similar in central vein and branch vein occlusion patients. CONCLUSION: Lipoprotein (a) has been shown to be correlated with cardiovascular disorders and may also be involved in retinal vein occlusion, probably by dysfunction of the fibrinolytic system. However, it does not seem to be a prognostic factor of retinal vein occlusion and its role has to be elucidated in further studies.

Adolescent↗
PubMed1997

Indirect scatter laser photocoagulation to subfoveal choroidal neovascularization in age-related macular degeneration.

BACKGROUND: Occult choroidal neovascularization (CNV), poorly defined on fluorescein angiography, is present in the majority of patients with exudative complications of age-related macular degeneration. For patients who present with this type of subfoveal CNV but who have useful visual acuity, no form of treatment is of proven benefit. Accordingly, a pilot randomized trial of indirect laser treatment was performed. The rationale of this treatment was to inhibit the CNV through laser-induced effects on the retinal pigment epithelium. METHODS: Patients with occult subfoveal CNV without retinal pigment epithelial detachment and with visual acuity of 20/200 or better were randomized to treatment or control groups. A grid of laser burns was applied to the macula beyond the area of serous retinal detachment and of angiographically defined occult CNV. RESULTS: After an average follow-up of 38 months, there was no difference in mean final visual acuity (0.12 treated, 0.14 control) or clinical outcome between treated and untreated groups. Fluorescein angiography showed gradual enlargement in the occult CNV in 58% of eyes in both groups. A decrease in visual acuity to worse than 20/200 (54% of treated, 50% of control eyes) was associated with ingrowth of well-delineated CNV (6 treated, 7 control eyes) or progression to a fibroglial or atrophic scar (11 treated, 8 control eyes). CONCLUSIONS: No benefit was demonstrated for scatter photocoagulation of the macula in patients with age-related macular degeneration and occult subfoveal CNV with initially good visual acuity. There were, however, no complications related to treatment.

Aged↗
PubMed1997

Indocyanine green angiography of drusen.

PURPOSE: To analyze the indocyanine green angiographic findings of drusen in the early stages of age-related macular degeneration. METHODS: Sixty-nine eyes of 53 consecutive patients with drusen but without exudative complications of age-related macular degeneration were studied. Drusen were classified into four groups: hard drusen, drusen derived from clusters of hard drusen (hard cluster-derived drusen and soft cluster-derived drusen), membranous drusen, and regressing drusen. An additional category was constituted by reticular pseudodrusen that could be associated with drusen of either the inner or outer macula. Results of contact lens biomicroscopy and fluorescein angiography were compared with findings on indocyanine green angiography. RESULTS: Hard drusen, either isolated hard drusen or hard cluster-derived drusen, were hyperfluorescent during indocyanine green angiography; in contrast, all sizes of soft drusen derived from clusters of hard drusen were hypofluorescent throughout the angiogram. Membranous drusen, visible on biomicroscopy and fluorescein angiography, were not visible during indocyanine green angiography. Regressing drusen may have showed hyperfluorescence at the early stages of indocyanine green angiography, but associated calcium and pigmentation were hypofluorescent. Reticular pseudodrusen were visible on red-free photographs; on midphase and late-phase indocyanine green angiography using the scanning laser ophthalmoscope only, reticular pseudodrusen were seen as a pattern of hypofluorescent dots. CONCLUSION: The indocyanine green angiographic findings add to and support the clinicopathologic classification of drusen. Indocyanine green angiography may help to distinguish the different types of drusen and may thus be of use in evaluating the risk of progressive age-related macular degeneration in patients with drusen.

Adult↗
PubMed1996

[Age-related macular degeneration].

Age-related macular degeneration is the leading cause of non treatable blindness in industrialized countries. The impairment of visual acuity is preceded by the occurrence of "precursors" some of which are the witness of aging and others are the first symptoms of age-related degeneration of the macular retina. The disease involves both eyes with time resulting in a major handicap. Eventually, central visual acuity is destroyed, making reading, writing and recognition of faces impossible. Different clinical types are identified: the atrophic form for which there is at present no possibility of treatment, and the neovascular form in which the destruction of the new vessels with laser photocoagulation is beneficial. However, only an early diagnosis and treatment may allow a preservation of central vision. New possibilities of angiographic diagnosis, new therapeutic approaches (macular surgery or transplantation) based on physiopathogenic research, provide new hopes.

Age Factors↗
PubMed1996

[Hereditary retinal diseases].

Hereditary retinal dystrophies can be subdivised into central (macular) and peripheral degenerations. Stargardt disease, Best disease, cone dystrophy and retinoschisis, affecting children or young adults, are the 4 commonest macular dystrophies. Retinitis pigmentosa, with primary affects photoreceptors, presents a wide clinical, genetic and molecular heterogeneity. It is certainly the most representative cause of peripheral degeneration. Recent advances in molecular biology allow a more complete clinical definition of these inheritable retinal diseases.

Adolescent↗
PubMed1996

Indocyanine green angiographic features of pathologic myopia.

PURPOSE: To analyze indocyanine green angiographic findings of pathologic myopia and compare them with those of fluorescein angiography, with particular reference to the usefulness of indocyanine green angiography in the management of neovascular complications. METHODS: Thirty-two consecutive patients (52 eyes) with pathologic myopia underwent a complete ophthalmologic examination including fluorescein and indocyanine green angiography. RESULTS: Retrobulbar arteries and veins were visualized solely on indocyanine green angiography in 33 (63%) of 52 eyes. Choroidal arteries appeared attenuated and reduced in number. In the area of staphyloma, choroidal veins were less numerous, and in all eyes an absence of the normal choroidal flush caused by the choriocapillaris filling was observed. Subretinal and retinal hemorrhages were present in 28 (54%) of 52 eyes. Choroidal neovascularization was diagnosed in 16 eyes on fluorescein angiography and in 18 eyes on indocyanine green angiography. In seven eyes, indocyanine green angiography disclosed lacquer cracks (without choroidal neovascularization), appearing in the late phases as hypofluorescent lines, as the probable cause of the subretinal and retinal hemorrhages. In only one eye did indocyanine green angiography fail to disclose choroidal neovascularization detectable on fluorescein angiography. In two eyes, neither dye could clarify the origin of the hemorrhages. CONCLUSIONS: Indocyanine green angiography allows identification of retrobulbar arteries and veins, and analysis of the altered choroidal vasculature. Moreover, indocyanine green angiography is a useful diagnostic tool to differentiate lacquer cracks from choroidal neovascularization in retinal and subretinal hemorrhages.

Adolescent↗