Biomedical subjects

Gisèle Soubrane

Publications and source records attributed to Gisèle Soubrane.

13 recordsLinked to original sources

PubMed2006

[Age-related macular degeneration].

Age-related macular degeneration (AMD) is the commonest overall cause of irreversible blindness in patients aged 50 or over in the western world. It is a spectrum of related diseases that have in common the progressive decline of vision as a consequence of dysfunction of the central retina and its underlying supporting elements, principally the retinal pigment epithelium and choroid in older adults. The disease has been traditionally classified into early and late stages with its dry and wet forms. Patients with age-related maculopathy should consider taking a dietary supplement such as that used in AREDS. There is no effective treatment for geographic atrophy. The exudative AMD is approached depending on the type and localisation of choroidal new vessels. Laser photocoagulation has only been shown to be beneficial for extra and juxtafoveal well defined lesions. PDT with verteporfin is effective in the management of patients with subfoveal predominantly classic lesions. A variety of molecules such as bevacizumab, pegaptanib sodium and ranibizumab, specifically targeted to different pathologic pathways in AMD, have been identified to their therapeutic potential. Research is actively being pursued in preclinical models both in academic laboratories and in the pharmaceutical industry, including multiple early stage clinical trials. There is no strong evidence to support benefits of submacular surgery in the management of neovascular AMD.

Humans↗

PubMed2006

Pigment epithelial changes in young women treated with photodynamic therapy and limited macular translocation for classic choroidal neovascularisation.

OBJECTIVES: The objectives of this study were to report peculiar postoperative changes at the level of the retinal pigment epithelium (RPE) in young women with moderate or mild myopia and classic choroidal neovascularisation first treated unsuccessfully with photodynamic therapy (PDT) and afterwards with limited macular translocation. METHODS: Retrospective review of two young myopic women who underwent PDT for treatment of idiopathic choroidal neovascularisation. Despite PDT, visual acuity decreased progressively, and limited macular translocation was performed 2-3 months later. RESULTS: During limited macular translocation (LMT) surgery, creation of retinal detachment using a 39-gauge cannula induced detachment of the RPE around the injection sites. Postoperatively, rounded flattened lesions were observed in both patients at the level of retinal pigment epithelium, with alternation of hyper- and hypopigmented rings around each site of injection. These alterations did not jeopardise visual recovery (20/25 and 20/40). CONCLUSIONS: The exceptional occurrence of pigment epithelial detachment during LMT surgery may suggest that PDT could predispose to these lesions by means of diffuse pigment epithelial changes. It encourages further studies to improve the understanding of RPE changes after PDT.

Adult↗

PubMed2006

Clinical evaluation of the use of indocyanine green for peeling the internal limiting membrane in macular hole surgery.

BACKGROUND: To evaluate the role of indocyanine green (infracyanine) in macular hole surgery. METHODS: A retrospective review of 38 consecutive eyes with macular hole, operated on with internal limiting membrane peeling (ILM), using or not using infracyanine (ICG), diluted in glucose 5% and filtered. Anatomical and functional results were analysed in each group, using visual field testing, fluorescein fundus angiography and particularly blue filter fundus photographs for the detection of retinal pigment epithelial changes and lesions of optic nerve fibres layer. RESULTS: Fifteen eyes underwent surgery without ICG and 23 eyes with ICG. The mean period of follow-up was 10 months. The duration of surgery was significantly lower in the group with ICG than without (P < 0.001). Overall, 84% of the holes closed without difference between both groups. The improvement in vision at 1, 6 and 12 months was similar in both groups. Fewer defects in the optic nerve fibres layer were observed in the group with ICG than without (P = 0.02). Staining with ICG revealed the presence of an associated epiretinal membrane in 61% of eyes, whereas it was clinically visible in only 17.5% before surgery. CONCLUSION: Using ICG for ILM peeling produced similar visual results to those obtained without ICG. It reduced significantly the duration of surgery and the trauma to the optic nerve fibres layer, without increasing the risk of retinal pigment epithelial damage. However, in the light of recent reports about the possible toxicity of ICG, its use should be restricted in clinical practice to difficult cases.

Aged↗

PubMed2006

Verteporfin photodynamic therapy for choroidal neovascularization associated with toxoplasmic retinochoroiditis.

PURPOSE: To evaluate the efficacy and safety of verteporfin photodynamic therapy (V-PDT) for young adults and children with subfoveal choroidal neovascularization (CNV) associated with toxoplasmic retinochoroiditis. METHODS: Patients with subfoveal CNV associated with toxoplasmic retinochoroiditis were treated with V-PDT and prospectively followed up. Before V-PDT and during follow-up, patients underwent visual acuity testing, complete ophthalmic examination including color photography, angiography with fluorescein and/or indocyanine green, and optical coherence tomography. The decision to retreat CNV was based on the criteria used in the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy investigation. RESULTS: Eight patients (5 males and 3 females) were treated at a mean age of 15.3 years (range, 5-31 years). CNV was 100% classic or predominantly classic in all study patients. Mean visual acuity increased from 20/225 (range, 20/400 to 20/50) to 20/123 (range, 20/200 to 20/25) during a mean follow-up period of 25 months (range, 5-49 months). Persistent closure of CNV was achieved in all eight patients (mean number of treatments, 1.75). Vascular anastomosis developed in the treated area in two patients, but there was no additional visual loss. No significant adverse effects of V-PDT were observed. CONCLUSION: V-PDT for subfoveal CNV associated with toxoplasmic retinochoroiditis appears to be effective and safe even in young adults and children. However, a longer follow-up is recommended to confirm our observations.

Adolescent↗

PubMed2006

Regulation of subfoveal choroidal blood flow in age-related macular degeneration.

PURPOSE: To assess the capability of the subfoveal choroidal circulation to regulate its blood flow in response to an acute increase in ocular perfusion pressure in the eyes of healthy elderly persons or of subjects with neovascular age-related macular degeneration (AMD). METHODS: Changes of subfoveal choroidal blood velocity (ChBVel), volume (ChBVol), and flow (ChBF) induced by isometric exercise were determined using laser Doppler flowmetry (LDF) in 19 young healthy volunteers (group 1), 24 elderly healthy volunteers with mild macular pigment distribution changes (group 2), and 23 subjects with subfoveal classic neovascularization caused by AMD (group 3). RESULTS: Isometric exercise induced significant increases in mean ocular perfusion pressure (PPm) of 19.5% +/- 4.9%, 20.2% +/- 3.8%, and 23.2% +/- 4.2%, for groups 1, 2, and 3, respectively (mean +/- 95% confidence interval). In groups 1 and 2, the increase in PPm did not induce significant changes in the mean values of the different LDF parameters. In group 3, however, ChBF increased significantly by 12.4% +/- 5.0%. No significant correlations were found between age and the changes of each of the LDF parameters and of PPm at the end of squatting for the young and elderly healthy groups. CONCLUSIONS: In response to an acute, moderate increase in PPm induced by isometric exercise, subfoveal choroidal blood flow behaves similarly in young and elderly healthy persons and is not significantly different from its value at rest. In contrast, in patients with neovascular AMD, this flow increases, indicating altered regulation in response to the increase in PPm.

Adult↗

PubMed2005

Y402H complement factor H polymorphism associated with exudative age-related macular degeneration in the French population.

PURPOSE: Identification of genetic factors for age-related macular degeneration (AMD) is of crucial importance in this common cause of blindness. A positive association between Y402H polymorphism of the complement factor H (CFH) gene and AMD has been recently reported in North American populations but not yet in European populations. The exudative form of AMD is rapidly progressive and usually associated with a severe prognosis. Our purpose was to investigate this association in a French population specifically affected with exudative AMD, in a case-control study. METHODS: Two series of unrelated exudative AMD patients, sporadic cases (n=60, mean age 74.9+/-5.7) and familial cases (n=81, mean age 74.0+/-9.4) were compared with healthy controls (n=91, mean age 74.6+/-6.3). The coding region of exon 9 of CFH was examined for the Y402H polymorphism by PCR-direct sequencing. RESULTS: The 1,279-C allele frequencies were significantly higher in exudative AMD patients than controls (0.564 compared to 0.302; p<0.0001). Genotypic distribution of the Y402H polymorphism was significantly different between sporadic cases compared to controls (chi2=14.48 with 2 df, p<0.0007) and between familial cases compared to controls (chi2=23.78 with 2 df, p<0.0001). The odds ratio (OR) for exudative AMD was 3.00 CI95% (1.60-5.62) for heterozygotes (CT) and 6.93 CI95% (3.11-15.46) for homozygotes (CC). CONCLUSIONS: These results suggest the contribution of the Y402H polymorphism of the CFH gene to exudative AMD susceptibility also in the French population. This relationship with the CFH may lead to early detection and new strategies for prevention and treatment of AMD.

Aged↗

PubMed2005

Stage 3 macular hole: role of optical coherence tomography and of B-scan ultrasonography.

PURPOSE: To analyze the various aspects of Stage 3 macular hole with optical coherence tomography (OCT) and B-scan ultrasonography. DESIGN: Observational case series. METHODS: Patients referred for full-thickness macular hole were prospectively screened with OCT and B-scan ultrasonography. OCT examination analyzed the diameter of the hole, the posterior hyaloid, the surrounding retina, and the inconstant presence of a pseudo-operculum. B-scan ultrasonography permitted the distinction between stage 3 and stage 4 holes, based on the detachment of the posterior hyaloid. RESULTS: The study included 62 eyes with stage 3 holes. On OCT, the typical aspect with a hyaloid detached from the macular area was observed in 37% of the eyes (group 3C). In 42% of the eyes (group 3B), a focal adherence was visible at the margin of the hole, as in stage 2 macular hole, but the hole was long-standing, large, and noneccentric. In 21% of the eyes, the hyaloid was not visible anterior to the retina but was still adherent to it (group 3A). In the absence of B-scan ultrasonography, these OCT features could be confused with a stage 4 macular hole. No difference in the size of the hole was observed between subgroups. CONCLUSION: OCT can show various aspects of stage 3 macular holes. B-scan ultrasonography was useful for assessing the location of the posterior hyaloid and to distinguish stage 3 from stage 4 macular holes. These features may provide additional information on the pathogenesis of macular hole and may have therapeutic implications.

Aged↗

PubMed2004

Acute severe visual acuity decrease after photodynamic therapy with verteporfin: case reports from randomized clinical trials-TAP and VIP report no. 3.

PURPOSE: To describe in detail occurrences of acute severe visual acuity decrease after photodynamic therapy (PDT) with verteporfin in the Treatment of Age-related macular degeneration with Photodynamic therapy (TAP) Investigation and the Verteporfin In Photodynamic therapy (VIP) Trial. DESIGN: Observational case series. METHODS: Retrospective review of all cases that developed acute severe visual acuity decrease after treatment. RESULTS: Of 15 acute severe visual acuity decrease events originally identified in 14 eyes of 14 patients, one event in one patient was judged unlikely to have been an acute severe visual acuity decrease event on retrospective review of these events in preparation of this report. Eleven events occurred after the first treatment. At follow-up, 10 improved by at least 1 line in visual acuity from the level noted at the time of the event. Of the nine patients returning for the month 24 examination, visual acuity decreased at least 3 lines from baseline in six, including at least 6 lines in four, and remained within 1 line in three. Associated abnormal morphology included three with a serous macular detachment and abnormal choroidal hypofluorescence, four with macular hemorrhage, three with a greenish subfoveal hemorrhage, and four with no abnormality. Events appeared to be more likely when patients had a visual acuity of 20/50 or better. CONCLUSIONS: Acute severe visual acuity decrease after PDT with verteporfin was an uncommon event; the risk did not outweigh the benefits of therapy previously reported. When considering verteporfin therapy, patients should be warned of the possibility of this serious adverse event.

Acute Disease↗

PubMed2003

Management of branch retinal vein occlusion with vitrectomy and arteriovenous adventitial sheathotomy, the possible role of surgical posterior vitreous detachment.

BACKGROUND: To analyze the results of vitrectomy and adventitial sheathotomy in the management of branch retinal vein occlusion (BRVO). This is a nonrandomized interventional case series. METHODS: Patients with BRVO with progressive decrease in visual acuity underwent surgery and were prospectively evaluated in two centers. Surgical procedure included a 3-port pars plana vitrectomy, removal of the internal limiting membrane and arteriovenous crossing sheathotomy. Clinical evaluation consisted of best-corrected visual acuity, fluorescein angiography and optical coherence tomography. RESULTS: Thirteen eyes were analyzed consecutively. An improvement in visual acuity of two ETDRS lines or more was observed in nine eyes (69%). The mean gain was 1.9 ETDRS lines. The absence of previous posterior vitreous detachment (PVD), poor initial visual acuity and the presence of retinal ischemia were correlated to the improvement in vision (P=0.014, P=0.002 and P=0.052, respectively). Eyes with initial PVD had a mean loss postoperatively of -5.7 lines, but eyes without PVD experienced a gain of 4.2 lines (P<0.001). Macular edema decreased significantly (preoperative thickness: 714 micro m, postoperative thickness: 353 micro m, P=0.04), whereas the aspect of the vein at the crossing and the non-perfused area remained unchanged. CONCLUSION: Vitrectomy with sheathotomy seems to be of benefit in the management of BRVO, particularly in eyes with no previous PVD, and the main postoperative feature was the decrease in macular edema. The surgical detachment of posterior hyaloid could be as important (or more) as the sheathotomy itself. Further studies are needed to define the most efficient surgical management of BRVO.

Adult↗

PubMed2003

The burden of age-related macular degeneration: results of a cohort study in two French referral centres.

OBJECTIVE: To describe the economic impact of age-related macular degeneration (AMD) and to assess its medical and non-medical costs. DESIGN AND SETTINGS: An observational study was carried out in 105 patients in two French centres in a sample of 105 French patients. All consecutive patients, consulting during a 3-week period, were included provided they were 60 years of age or older and they presented an exudative form of AMD with a distant visual acuity in the best eye < or = 20/40. Data collected included clinical items, treatment modalities, medical follow-up, transport costs, impact of AMD on living conditions and welfare payments related to visual impairment. Costs were presented in 2000 values. PERSPECTIVE: General payer perspective (Social Security, private health insurance and patient). RESULTS: Mean age was 79.3 years and ranged from 62.8-95 years. Average length of disease evolution was 3.5 years. During a 3-month period, patients had a mean of 2.6 visits to the ophthalmologist. Thirty percent of the patients used vascular medications and 72.4% had been previously treated by laser photocoagulation. Only 10% had benefited from visual rehabilitation. Annual AMD cost per patient was 3660.29 euros (EUR) [95% CI: 2881.92-4438.62]. Half of these annual costs were medical costs. Other major cost components were home help costs EUR904.91 [95% CI: 478.88-1330.94] and transport costs for care EUR542.73 [95% CI: 146.31-939.14]. Non-medical costs were significantly higher for patients with more severe disease. CONCLUSIONS: The economic argument that costs are higher in patients with the lowest visual acuity emphasises the necessity of early detection and treatment of patients with AMD.

Aged↗

PubMed2002

[Age-related macular degeneration].

UNLABELLED: EPIDEMIOLOGICAL AND PATHOGENIC DATA: Age-related macular degeneration (ARMD) is the first cause of blindness in industrialized countries in patients over the age of 55. Its prevalence increases with age, affecting up to 25% of the population aged over 75. The pathogenesis of this disease is not well known. Not only aging, but also other varying degrees of genetic and environmental factors are implied. CLINICAL ASPECTS: Precursors (first clinical signs of ARMD) can be observed on examination of the fundus: drusen (localized deposits of lipids and lipoproteins) and alterations in retinal pigment epithelium (RPE) (hypo- or hyperpigmentation). Two forms of complications are observed: atrophic (or "dry") and exudative (or "wet"). The atrophic form is defined by the presence of degeneration in the central RPE, choriocapillaris and photoreceptors, resulting from the enlargement and/or coalescence of small areas of peri-foveolar atrophy (or "geographic" atrophy). The exudative form, responsible for the majority of cases of blindness due to ARMD, is characterized by the appearance of choroidal new vessels, identifiable on fluorescein angiography and responsible for serous retinal detachment, edema and hemorrhage, leading to the destruction of the macular photoreceptors. FROM A THERAPEUTIC POINT OF VIEW: Treatment of the atrophic form is currently only palliative (visual aids and re-habilitation of low vision). Treatments of the exudative form having demonstrated their efficacy are laser photocoagulation and dynamic phototherapy with verteporfine, providing relative stabilization of visual acuity in around 2/3 of the eyes. Other treatments are under evaluation: anti-angiogenic treatments, surgical techniques (ablation of the new vessels, foveal translocation), new laser treatments (transpupillary thermotherapy, selective photocoagulation of the feeder vessels). Photoreceptor and pigment epithelium transplantations or implantation of microphotodiodes represent other long-term alternatives.

Aged↗

PubMed2002

Presentation delay in patients affected with exudative age-related macular degeneration.

BACKGROUND: Presentation delay (i.e. duration of visual symptoms before initial presentation) is an established critical parameter for visual prognosis in patients with exudative age-related macular degeneration (ARMD) considering the natural history of the disease and the limitations of current treatments. The purpose of this study was to determine the duration of presentation delay and its evolution in two periods 4 years apart. METHODS: Presentation delay in 1598 patients affected with exudative ARMD was retrospectively reviewed during two similar 8-month periods in 1994 and 1998 in a tertiary referral center. RESULTS: The proportions of patients examined either within 1 month, between 1 and 3 months, and between 3 and 6 months after onset of symptoms, respectively, increased between 1994 and 1998 from 23% to 33%, from 27% to 32.5%, and from 14% to 18.5%. The proportions of patients examined between 6 and 12 months and after 12 months decreased from 16% to 12% and from 20% to 4%, respectively. Furthermore, the proportion of patients presenting with a first eye involvement during the first month following the onset of symptoms rose from 42% in 1994 to 52% in 1998. All these differences were statistically significant. CONCLUSION: This first specific review of presentation delay in exudative ARMD showed a significant decrease in this parameter between 1994 and 1998 that should be taken into account when assessing the overall evolution of visual outcome. Further studies are warranted to ascertain that these findings reflect a global improvement in the management of macular diseases.

Fluorescein Angiography↗

PubMed2002

Surgical treatment of subfoveal neovascularization in myopia: macular translocation vs surgical removal.

PURPOSE: To compare the visual outcome of two different surgical approaches for subfoveal neovascularization in degenerative myopia: macular translocation and surgical removal of choroidal neovascularization (CNV). DESIGN: Interventional case series. METHODS: Retrospectively, 32 eyes with degenerative myopia (axial length over 26 mm or refraction over -6 diopters) and subfoveal CNV of 32 consecutive patients operated on by either surgical removal of CNV or limited macular translocation were reviewed. Surgical removal of CNV was performed in 18 eyes and limited macular translocation with a twofold suture in 14 eyes. The main outcome measurements were best-corrected visual acuity (BCVA) and findings from fluorescein angiography. Postoperatively, mean +/- SD follow up was 14 +/- 15 months (range, 6-48 months) in the removal group and 11 +/- 4 months (range, 6-24 months, P =.37) in the translocation group. RESULTS: In both groups, there was no significant difference in preoperative age, sex, refractive error, or BCVA. The average of postoperative BCVA was statistically better after macular translocation (10 ETDRS lines or 20/100) than after surgical removal (6 lines 10/125, P =.019). Visual acuity improved by 3.8 lines after macular translocation and was unchanged after surgical removal (-0.7 line, P =.011). Macular translocation was successful in shifting the CNV to an extrafoveal location in 11 out of 14 eyes. Mean foveal displacement of all 18 translocated eyes was 695 +/- 426 microm (range, 100-1520 microm). Recurrence of CNV occurred in seven eyes (39%) after surgical removal and in two eyes (14%) after translocation. Retinal detachment occurred in two eyes in each group. CONCLUSION: In this retrospective study, eyes with degenerative myopia and subfoveal neovascularization treated with limited macular translocation had better visual acuity recovery than eyes treated with surgical removal of the choroidal neovascularization. Further studies are required to confirm these results.

Adult↗