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PURPOSE: To assess the impact of the measures taken during the lockdown period from March 17 to May 11, 2020 on the management of patients with exudative age related macular degeneration treated by intravitreal anti-VEGF injections at the University Hospital of Tours. METHODS: In this retrospective study, patients were included after analysis of the computerized medical records of patients with age related macular degeneration. Those who were treated for exudative age related macular degeneration who received at least 1 intravitreal injection in the 12 months prior and at least one consultation in the 6 months prior to the lockdown period, were included. The initial and final mean visual acuity were compared with a 5 letter non-inferiority margin. A subgroup analysis was performed according to outcomes. The visual acuities immediately after this period were also recorded. RESULTS: In all, 595 eyes of 493 patients were included. The mean initial visual acuity was 59.6 letters, vs. 58.5 for the final visual acuity, i.e. a difference of -1.13 letters with a lower limit of the confidence interval of less than 5. The visual acuity on release from lockdown was comparable to the other 2 measurements. Initial visual acuity and the number of missed treatments were the main factors associated with functional loss. CONCLUSION: Patients' visual acuity during the lockdown period was able to be maintained despite the restrictive measures and limitation of care access in France. The most common cause of substantial visual decline was missed intravitreal injections.

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INTRODUCTION: The main objective of this study was to investigate the rate of ophthalmological screening for diabetic retinopathy in diabetic individuals in the Centre-Val de Loire (CVDL) region. This study secondarily aimed to identify factors associated with regular ophthalmological screening. MATERIAL AND METHODS: Data were extracted from the French national healthcare database (SNDS). Individuals were identified on the basis of reimbursements for antidiabetic medications. Patients who were identified as having at least one reimbursed eye examination between 2015 and 2016 were considered as having regular follow-up. RESULTS: In total, 118,181 diabetic individuals residing in CVDL were identified in the SNDS, and 74,048 had undergone ophthalmological screening. The rate of eye examination was 62.7% between 2015 and 2016 and was highly variable within the region (from 65.6% in Loiret to 54.0% in Cher). The main factors associated with regular eye screening were: follow-up with an established primary care physician (OR=2.88), regular follow-up with a diabetologist (OR=2.14), and regular follow-up with an internist (OR=1.57). CONCLUSION: This study suggests that ophthalmological screening for diabetic retinopathy in individuals with diabetes in the CVDL region could be significantly improved, particularly in rural areas. Factors influencing compliance with follow-up are multiple but appear mainly related to the patients' quality of overall medical management. These findings highlight the need for public health policies to improve detection and prevention of diabetic retinopathy by promoting comprehensive medical care for diabetic individuals.

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INTRODUCTION: Sickle cell retinopathy is the main ophthalmologic complication of sickle cell syndrome. Optical coherence tomography (OCT) and optical coherence tomography-angiography (OCT-A) permit demonstration of central retinal involvement. The goal of this study is to determine whether central retinal involvement is predictive of peripheral retinal ischemia. MATERIALS AND METHODS: We carried out a retrospective study of 31 patients with sickle cell disease who underwent a complete ophthalmologic examination. We focused on capillary density of the superficial and deep plexuses and the central avascular surface by OCT-A, and retinal layer thickness by OCT. All of the findings obtained by OCT-A and OCT were classified according to the Goldberg stages on fluorescein angiography. RESULTS: A thinning of the mean and temporal deep plexus capillary layer as well as a loss of the temporal density of the superficial plexus capillaries are significantly higher in the case of proliferative sickle cell retinopathy (P=<0.05). A significant negative correlation is observed between the mean and temporal density of the superficial (R=-0.31; P=0.02 and R=-0.43; P=0.0009) and deep plexus capillaries (R=-0.39; P=0.003 et R=-0.43; P=0.0009) and the Goldberg stage in fluorescein angiography. CONCLUSION: The study of the temporal capillary densities of the superficial and deep plexuses on OCT angiography may prove to be a useful tool for the ophthalmologist in order to diagnose patients at risk for proliferative sickle cell retinopathy.

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PURPOSE: To demonstrate a decrease in distance visual acuity (VA) following instillation of mydriatic eyedrops in eyes with exudative age-related macular degeneration (AMD). MATERIALS AND METHODS: A prospective assessment in clinical practice was conducted in our ophthalmology department at the University Hospital of Tours from 7/19/2018 to 8/29/2018. Distance (ETDRS) and near (Parinaud) VA were assessed before and after instilling one drop each of tropicamide 0.5% and phenylephrine 10% in the 40 included eyes with exudative AMD. RESULTS: The mean difference in distance VA before and after pupillary dilation (PD) was 0.06 LogMAR (SD=0.14) (P<0.01), i.e. -3.05 letters read (SD=7.52) on the ETDRS chart (P=0.01). For near VA, the mean difference was 0.16 LogMAR (SD=0.16) (P<0.001), i.e. -1.58 paragraphs read (SD=1.63) on the Parinaud chart (P<0.001). DISCUSSION: The absence of a clinically significant loss in post-dilation distance VA for exudative AMD could be explained by negligible glare coming from the ETDRS chart, milder photophobia, low pre-dilation VA's and a balance between higher order optical aberrations and diffraction. The opposite result for near VA could essentially be explained by greater glare induced by the light illuminating the Parinaud chart. CONCLUSION: Our primary goal was not achieved. A study presuming the absence of a clinically significant decrease in post-dilation distance VA would be necessary to consider directly measuring post-dilation VA in eyes with exudative AMD in our daily practice.

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INTRODUCTION: Vitreoretinal lymphoma is a serious disease with highly varied clinical presentations. The goal of this work is to identify the various presentations (clinical, imaging) in order to improve screening for this disease. MATERIALS AND METHOD: We collected data of patients followed on our service for vitreoretinal lymphoma. The fundus exam, autofluorescence and angiography data were classified in order to identify signs, which might lead to earlier diagnosis of lymphoma. RESULTS: The diagnosis of vitreoretinal lymphoma was confirmed by vitrectomy or cerebral biopsy for 12 patients (8 women and 4 men). Three clinical presentations were identified: no retinal involvement (2 patients), retinal infiltrate (4 patients) or acute retinal necrosis (3 patients). One patient had no imaging (deceased before it could be obtained), and two patients had uninterpretable imaging. CONCLUSION: Vitreoretinal lymphoma remains a rare and under-diagnosed disease. The prognosis is related to early diagnosis. Multimodal imaging can help to diagnose early vitreoretinal lymphoma in some cases.

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PURPOSE: To evaluate the safety and explore the efficacy of intravitreal injection of ranibizumab 0.5mg in treatment of large peripapillary choroidal neovascularization. METHODS: This single-center, prospective, interventional, noncomparative, nonrandomized clinical case series study included six consecutive patients with large or recurrent peripapillary choroidal neovascularization. Ranibizumab 0.5mg was administered at baseline, and then monthly following the development of hemorrhage or subretinal fluid associated with visual symptoms. The response to treatment was assessed in terms of changes in lesion characteristics as measured by FA and change in visual acuity (VA). RESULTS: Six patients (seven eyes with peripapillary choroidal neovascularization) were enrolled. three of the seven eyes had choroidal neovascularization associated with angioid streaks, two had idiopathic neovascularization, and the last eye had peripapillary neovascular membrane associated with age-related macular degeneration. The median follow-up was 12 months (+/-3 months). At 1 year, the best-corrected visual acuity improved from +0.74 log Mar to +0.45 log Mar (p=0.0431), with resolution of intraretinal fluid. On average, four intravitreal injections of ranibizumab (0.5mg) were required during this year. DISCUSSION: Laser photocoagulation treatment, photodynamic therapy, or subretinal surgery are limited by the high recurrence rate, the difficulty in assessing the true extent of the lesion, and the difficulty in improving visual function. CONCLUSION: Intravitreal ranibizumab injections appeared to be a good therapeutic option for patients with peripapillary CNV in the short term. Long-term follow-up of these patients will aid in assessing the sustained effect of the drug.

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We report the case of a 9-year-old girl with a long-chain 3-hydroxyacyl CoA dehydrogenase (LCHAD) deficiency. This enzyme participates in mitochondrial fatty acid B-oxidation. Genetic fatty acid oxidation defects induce cellular energetic deficiency, and thus early life-threatening manifestations. An appropriate diet prevents these severe disorders. Nevertheless, LCHAD deficiency is the only B-oxidation enzymatic disorder that induces a chorioretinopathy, predominating at the posterior pole. We describe the first case of bilateral macular choroidal neovascularization. One eye presented a fibrovascular lesion. The other eye presented an active neovascularization stabilized by two dynamic phototherapies. The specificity of choroidal degeneration related to LCHAD deficiency remains unknown. Reviewing of literature and biochemical mechanisms suggests that fatty acid oxidative stress rather than a mitochondrial energetic defect is involved. For practical purposes, this report emphasizes the importance of ophthalmological follow-up of these patients.

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The authors analyzed the post operative results of the penetrating keratoplasty after removal suture in Ophthalmology Service of University and Hospital's Center in Tours. The age of patients varied 20 to 90 years with an average of 56,83 years. 41,71% of patients had a pseudophakic or aphakic bullous keratopathy. Ocular hypertony was the most frequently post operative complication (63,67%). Final removal's suture improved the transparency of grafts and so the visual acuity in spite of greater endothelial cell loss (65,65%) and residual corneal oedema.

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Les auteurs ont analyse les resultats post operatoires de la keratoplastie transfixiante apres ablation des sutures dans le service d'Ophtalmologie du Centre Hospitalier Universitaire de Tours. L'age des patients variait de 20 a 90 ans avec une moyenne de 56;83 ans. 41;7des patients avaient une keratopathie bulleuse de l'aphake ou du pseudophake. L'hypertonie oculaire etait la complication post operatoire la plus frequente. L'ablation definitive des sutures a ameliore la clarte du greffon et donc l'acuite visuelle malgre l'importance de la perte cellulaire endotheliale (65;65a un an) et de l'oedeme corneen residuel

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