To evaluate the efficacy of intravitreal aflibercept injection (IAI) for vitrectomized eyes with ... more To evaluate the efficacy of intravitreal aflibercept injection (IAI) for vitrectomized eyes with diabetic macular edema (DME) at two years. Methods: This is a prospective, non-comparative, multicenter observational study including diabetic patients with visual acuity between 20/400 to 20/40 due to DME, who have undergone vitrectomy at least 3 months before the first aflibercept injection. Treatment protocol included 5 monthly aflibercept injection followed by a ProReNata regimen during the first year. Participants were managed at clinicians' discretion using Treat and Extend or Observe and Plan regimen during the second year. Visual acuity, OCT findings and number of IAI were assessed at two years. Results: Available data for 28 eyes with DME previously vitrectomized treated with aflibercept intravitreal injection during at least 2 years were collected. Visual gain was +5.4 letters (p = 0.01), and central macular thickness decreased significantly −62µm, p < 0.001) at 2 years. Resolution of macular edema allowing discontinuation of aflibercept was observed in 7 eyes (15%). Mean number of injections was 14.6, and mean interval injection was 6.4 weeks for 2 years. Conclusion: These results suggest that IAI is beneficial in vitrectomized eyes leading to improvement of visual and anatomical outcome which was maintained for 2 years.
Ophthalmic Surgery, Lasers and Imaging Retina, 2018
Retinal arteriovenous malformation (AVM) is a rare unilateral developmental disease that is stabl... more Retinal arteriovenous malformation (AVM) is a rare unilateral developmental disease that is stable over time in most cases. The authors present a case of a man who was diagnosed with an asymptomatic juxtapapillary AVM of the left eye at the age of 25 years. Visual acuity was 20/20. Fundus pictures realized during an 11-year follow-up disclosed a slowly progressive enlargement of the lesion with vascular loops increasing in number and size. Vision remained stable. No complication was observed. This case demonstrates that retinal AVMs may progressively grow and remain asymptomatic and uncomplicated for a long period of time. [ Ophthalmic Surg Lasers Imaging Retina. 2018;49:e284–e286.]
Introduction L’œdeme maculaire de l’obliteration veineuse retinienne reste une complication a ris... more Introduction L’œdeme maculaire de l’obliteration veineuse retinienne reste une complication a risque de malvoyance en cas de bilateralisation. Le mecanisme est multi factoriel expliquant l’absence de consensus therapeutique. Presentation de 4 patients âges de plus de 65 ans, strictement monophtalmes apres complications d’obliteration veineuse retinienne anterieure et presentant une recidive controlaterale plusieurs annees apres, avec œdeme maculaire. Objectifs et Methodes Evaluation du statut visuel et du retentissement social a 12 mois apres strategie therapeutique reflechie entre le patient et l’ophtalmologiste. Recueil des donnees pour chaque patient : interrogatoire oriente, acuite visuelle loin/pres, tonus oculaire, fond d’œil, angiographie et OCT. Exclusion des œdemes maculaires avec composante tractionnelle. 2 cas : perte plus ou moins complete de l’autonomie : choix d’un traitement chirurgical. 2 autres cas : aucune alteration des activites courantes malgre un important œdeme maculaire menacant a long terme le pronostic visuel : choix d’un traitement medical. Observation Les moyens therapeutiques invasifs, reserves aux 2 premiers cas ont permis d’ameliorer leur fonction visuelle et de reprendre leur activite quotidienne sans aucun effet indesirable. Le choix d’un traitement medical et/ou d’une surveillance simple pour les 2 derniers cas n’a pas modifie leur activite courante et a permis dans un cas d’observer une disparition complete de l’œdeme maculaire. Discussion Il n’existe pas actuellement de conduite a tenir claire face a l’œdeme maculaire apres obliteration veineuse retinienne. De nombreuses etudes multicentriques regionales sont en cours pour preciser la place des differents traitements face a l’œdeme maculaire potentiellement invalidant. Conclusion La presentation de ces 4 situations cliniques montrent que le choix therapeutique reste essentiellement guide par l’importance et l’evolution de la baisse d’acuite visuelle en tenant compte egalement du retentissement social. Ces exemples pourraient egalement aider a definir un organigramme decisionnel.
Nous rapportons l'observation d'une femme de 58 ans presentant des alterations chorioreti... more Nous rapportons l'observation d'une femme de 58 ans presentant des alterations chorioretiniennes non evolutives, a limites nettes, unilaterales a type d'atrophie et de dispersion pigmentaire, ayant pu faire evoquer une retinopathie pigmentaire. L'examen de l'oeil atteint objectivait une acuite visuelle reduite a la perception des mouvements de la main. L'oeil adelphe etait strictement normal. L'exploration electrophysiologique allait a l'encontre d'une retinopathie pigmentaire. On notait une hypoplasie du malaire homolaterale non evolutive et l'interrogatoire revelait un accouchement difficile par forceps, L'etiologie retenue de cet alteration du fond d'oeil est un traumatisme obstetrical. L'hemiatrophie faciale progressive est le diagnostic differentiel evoque.
to evaluate the efficacy and the safety of low dose intraocular tissue plasminogen activator (rt-... more to evaluate the efficacy and the safety of low dose intraocular tissue plasminogen activator (rt-PA) in the treatment of traumatic hyphema and postoperative fibrinous membrane. Six microg to 10 microg of rt-PA was injected into the anterior chamber to treat severe fibrinous postoperative membranes and total traumatic hyphemae. Thirteen eyes of 13 patients were treated. Four cases of traumatic hyphema and 9 cases of fibrinous membranes were included. Complete fibrinolysis within 24 hours was observed in 4 cases (30.8%). A partial success was noted in 7 eyes (53.8%). No beneficial effect was observed in two cases of traumatic hyphema associated with intravitreal hemorrhage after penetrating trauma. No side effect attributable to rt-PA occurred. Low dose intraocular rt-PA appears to be safe and effective in the treatment of postoperative fibrinous membrane and endocular hemorrhage limited to the anterior chamber.
nesunats h long terne de la vitrectomie au cours des oedèmes maculaires diabéüques associés h une... more nesunats h long terne de la vitrectomie au cours des oedèmes maculaires diabéüques associés h une conîraction de la hyaloïde postérieure. Long ierm m i i s of vhcîamy for diabebic mswlar edema associaimi wiïh posMor hyaioidal üaciion.
The aim of this study was to evaluate the direct effect of surgical treatment of subfoveolar neov... more The aim of this study was to evaluate the direct effect of surgical treatment of subfoveolar neovascular membranes in age related macular degeneration to macular functions. Thirteen eyes of 13 patients were included in this study. Macular function was assayed by visual acuity and central visual field using the Octopus perimeter before surgery and in the first three post operative months. Pre and post operative fluorescein angiography frames were digitalized and the size of each lesions were compared. After a 3 months follow up, visual acuity remained stable or improved in 66% of the patients. However, visual acuity was better than 0.1 in 15% of the patients. Central visual field comparison disclosed a significant worsening of the retinal sensitivity in the 3 degree field surrounding the central point. On fluorescein frames, submacular scar was 141% of the size of the neovascular membrane. After a mean follow up of 6.9 months (range 3-14), one case of recurrence occurred. A cataract ...
Retinal detachment (RD) is a major complication of cataract surgery, which can be treated by eith... more Retinal detachment (RD) is a major complication of cataract surgery, which can be treated by either primary vitrectomy without indentation or the scleral buckling procedure. The aim of this study is to compare the results of these two techniques for the treatment of pseudophakic RD. The charts of 40 patients (40 eyes) treated with scleral buckling for a primary pseudophakic RD were retrospectively studied and compared to the charts of 32 patients (32 eyes) treated with primary vitrectomy without scleral buckle during the same period by the same surgeons. To obtain comparable samples, patients with giant retinal tears, vitreous hemorrhage, and severe preoperative proliferative vitreoretinopathy (PVR) were not included. Minimal follow-up was 6 months. The primary success rate was 84% in the vitrectomy group and 82.5% in the ab-externo group. Final anatomical success was observed in 100% of cases in the vitrectomy group and in 95% of cases in the ab-externo group. Final visual acuity w...
The authors report a case of unilateral, stable, localized, and well-circumscribed choriocapillar... more The authors report a case of unilateral, stable, localized, and well-circumscribed choriocapillaris atrophy associated with retinal pigment epithelium dispersion and atrophy. The anterior segment was normal. Facial examination revealed a homolateral malar hypoplasia. The other eye was normal. The electrophysiologic study did not confirm pigmentary degeneration of the retina. The patient's history included a difficult delivery using obstetrical forceps. The authors review the main ocular lesions secondary to birth trauma. In this case, they favored a traumatic chorioretinal lesion secondary to an obstetrical traumatism. In this context, progressive facial hemiatrophy is the main differential diagnosis.
To investigate whether peroperative perfluorocarbon liquids (PFCL) improve the long term anatomic... more To investigate whether peroperative perfluorocarbon liquids (PFCL) improve the long term anatomical success of retinal detachment associated with severe proliferative vitreoretinopathy (PVR). The charts of 62 successive patients operated on for retinal detachment associated with severe PVR were retrospectively analyzed. For one group of 39 patients PFCL were used intraoperatively to improve membrane dissection. The anatomical status of the two groups were compared one month after surgery and at least 6 months after silicone oil ablation. Anatomical success was observed in 84.6% in the group of patients operated with PFCL compared to 52% in the other group (P = 0.005). At the end of the follow up, anatomical success was observed in 64% of patients operated with PFCL compared to 61% in the control group (P = 0.8). However, recurrences were observed later in the group operated on with PFCL. Perfluorocarbons liquids significantly improve the initial reattachment of retinal detachment co...
To evaluate the efficacy of intravitreal aflibercept injection (IAI) for vitrectomized eyes with ... more To evaluate the efficacy of intravitreal aflibercept injection (IAI) for vitrectomized eyes with diabetic macular edema (DME) at two years. Methods: This is a prospective, non-comparative, multicenter observational study including diabetic patients with visual acuity between 20/400 to 20/40 due to DME, who have undergone vitrectomy at least 3 months before the first aflibercept injection. Treatment protocol included 5 monthly aflibercept injection followed by a ProReNata regimen during the first year. Participants were managed at clinicians' discretion using Treat and Extend or Observe and Plan regimen during the second year. Visual acuity, OCT findings and number of IAI were assessed at two years. Results: Available data for 28 eyes with DME previously vitrectomized treated with aflibercept intravitreal injection during at least 2 years were collected. Visual gain was +5.4 letters (p = 0.01), and central macular thickness decreased significantly −62µm, p < 0.001) at 2 years. Resolution of macular edema allowing discontinuation of aflibercept was observed in 7 eyes (15%). Mean number of injections was 14.6, and mean interval injection was 6.4 weeks for 2 years. Conclusion: These results suggest that IAI is beneficial in vitrectomized eyes leading to improvement of visual and anatomical outcome which was maintained for 2 years.
Ophthalmic Surgery, Lasers and Imaging Retina, 2018
Retinal arteriovenous malformation (AVM) is a rare unilateral developmental disease that is stabl... more Retinal arteriovenous malformation (AVM) is a rare unilateral developmental disease that is stable over time in most cases. The authors present a case of a man who was diagnosed with an asymptomatic juxtapapillary AVM of the left eye at the age of 25 years. Visual acuity was 20/20. Fundus pictures realized during an 11-year follow-up disclosed a slowly progressive enlargement of the lesion with vascular loops increasing in number and size. Vision remained stable. No complication was observed. This case demonstrates that retinal AVMs may progressively grow and remain asymptomatic and uncomplicated for a long period of time. [ Ophthalmic Surg Lasers Imaging Retina. 2018;49:e284–e286.]
Introduction L’œdeme maculaire de l’obliteration veineuse retinienne reste une complication a ris... more Introduction L’œdeme maculaire de l’obliteration veineuse retinienne reste une complication a risque de malvoyance en cas de bilateralisation. Le mecanisme est multi factoriel expliquant l’absence de consensus therapeutique. Presentation de 4 patients âges de plus de 65 ans, strictement monophtalmes apres complications d’obliteration veineuse retinienne anterieure et presentant une recidive controlaterale plusieurs annees apres, avec œdeme maculaire. Objectifs et Methodes Evaluation du statut visuel et du retentissement social a 12 mois apres strategie therapeutique reflechie entre le patient et l’ophtalmologiste. Recueil des donnees pour chaque patient : interrogatoire oriente, acuite visuelle loin/pres, tonus oculaire, fond d’œil, angiographie et OCT. Exclusion des œdemes maculaires avec composante tractionnelle. 2 cas : perte plus ou moins complete de l’autonomie : choix d’un traitement chirurgical. 2 autres cas : aucune alteration des activites courantes malgre un important œdeme maculaire menacant a long terme le pronostic visuel : choix d’un traitement medical. Observation Les moyens therapeutiques invasifs, reserves aux 2 premiers cas ont permis d’ameliorer leur fonction visuelle et de reprendre leur activite quotidienne sans aucun effet indesirable. Le choix d’un traitement medical et/ou d’une surveillance simple pour les 2 derniers cas n’a pas modifie leur activite courante et a permis dans un cas d’observer une disparition complete de l’œdeme maculaire. Discussion Il n’existe pas actuellement de conduite a tenir claire face a l’œdeme maculaire apres obliteration veineuse retinienne. De nombreuses etudes multicentriques regionales sont en cours pour preciser la place des differents traitements face a l’œdeme maculaire potentiellement invalidant. Conclusion La presentation de ces 4 situations cliniques montrent que le choix therapeutique reste essentiellement guide par l’importance et l’evolution de la baisse d’acuite visuelle en tenant compte egalement du retentissement social. Ces exemples pourraient egalement aider a definir un organigramme decisionnel.
Nous rapportons l'observation d'une femme de 58 ans presentant des alterations chorioreti... more Nous rapportons l'observation d'une femme de 58 ans presentant des alterations chorioretiniennes non evolutives, a limites nettes, unilaterales a type d'atrophie et de dispersion pigmentaire, ayant pu faire evoquer une retinopathie pigmentaire. L'examen de l'oeil atteint objectivait une acuite visuelle reduite a la perception des mouvements de la main. L'oeil adelphe etait strictement normal. L'exploration electrophysiologique allait a l'encontre d'une retinopathie pigmentaire. On notait une hypoplasie du malaire homolaterale non evolutive et l'interrogatoire revelait un accouchement difficile par forceps, L'etiologie retenue de cet alteration du fond d'oeil est un traumatisme obstetrical. L'hemiatrophie faciale progressive est le diagnostic differentiel evoque.
to evaluate the efficacy and the safety of low dose intraocular tissue plasminogen activator (rt-... more to evaluate the efficacy and the safety of low dose intraocular tissue plasminogen activator (rt-PA) in the treatment of traumatic hyphema and postoperative fibrinous membrane. Six microg to 10 microg of rt-PA was injected into the anterior chamber to treat severe fibrinous postoperative membranes and total traumatic hyphemae. Thirteen eyes of 13 patients were treated. Four cases of traumatic hyphema and 9 cases of fibrinous membranes were included. Complete fibrinolysis within 24 hours was observed in 4 cases (30.8%). A partial success was noted in 7 eyes (53.8%). No beneficial effect was observed in two cases of traumatic hyphema associated with intravitreal hemorrhage after penetrating trauma. No side effect attributable to rt-PA occurred. Low dose intraocular rt-PA appears to be safe and effective in the treatment of postoperative fibrinous membrane and endocular hemorrhage limited to the anterior chamber.
nesunats h long terne de la vitrectomie au cours des oedèmes maculaires diabéüques associés h une... more nesunats h long terne de la vitrectomie au cours des oedèmes maculaires diabéüques associés h une conîraction de la hyaloïde postérieure. Long ierm m i i s of vhcîamy for diabebic mswlar edema associaimi wiïh posMor hyaioidal üaciion.
The aim of this study was to evaluate the direct effect of surgical treatment of subfoveolar neov... more The aim of this study was to evaluate the direct effect of surgical treatment of subfoveolar neovascular membranes in age related macular degeneration to macular functions. Thirteen eyes of 13 patients were included in this study. Macular function was assayed by visual acuity and central visual field using the Octopus perimeter before surgery and in the first three post operative months. Pre and post operative fluorescein angiography frames were digitalized and the size of each lesions were compared. After a 3 months follow up, visual acuity remained stable or improved in 66% of the patients. However, visual acuity was better than 0.1 in 15% of the patients. Central visual field comparison disclosed a significant worsening of the retinal sensitivity in the 3 degree field surrounding the central point. On fluorescein frames, submacular scar was 141% of the size of the neovascular membrane. After a mean follow up of 6.9 months (range 3-14), one case of recurrence occurred. A cataract ...
Retinal detachment (RD) is a major complication of cataract surgery, which can be treated by eith... more Retinal detachment (RD) is a major complication of cataract surgery, which can be treated by either primary vitrectomy without indentation or the scleral buckling procedure. The aim of this study is to compare the results of these two techniques for the treatment of pseudophakic RD. The charts of 40 patients (40 eyes) treated with scleral buckling for a primary pseudophakic RD were retrospectively studied and compared to the charts of 32 patients (32 eyes) treated with primary vitrectomy without scleral buckle during the same period by the same surgeons. To obtain comparable samples, patients with giant retinal tears, vitreous hemorrhage, and severe preoperative proliferative vitreoretinopathy (PVR) were not included. Minimal follow-up was 6 months. The primary success rate was 84% in the vitrectomy group and 82.5% in the ab-externo group. Final anatomical success was observed in 100% of cases in the vitrectomy group and in 95% of cases in the ab-externo group. Final visual acuity w...
The authors report a case of unilateral, stable, localized, and well-circumscribed choriocapillar... more The authors report a case of unilateral, stable, localized, and well-circumscribed choriocapillaris atrophy associated with retinal pigment epithelium dispersion and atrophy. The anterior segment was normal. Facial examination revealed a homolateral malar hypoplasia. The other eye was normal. The electrophysiologic study did not confirm pigmentary degeneration of the retina. The patient's history included a difficult delivery using obstetrical forceps. The authors review the main ocular lesions secondary to birth trauma. In this case, they favored a traumatic chorioretinal lesion secondary to an obstetrical traumatism. In this context, progressive facial hemiatrophy is the main differential diagnosis.
To investigate whether peroperative perfluorocarbon liquids (PFCL) improve the long term anatomic... more To investigate whether peroperative perfluorocarbon liquids (PFCL) improve the long term anatomical success of retinal detachment associated with severe proliferative vitreoretinopathy (PVR). The charts of 62 successive patients operated on for retinal detachment associated with severe PVR were retrospectively analyzed. For one group of 39 patients PFCL were used intraoperatively to improve membrane dissection. The anatomical status of the two groups were compared one month after surgery and at least 6 months after silicone oil ablation. Anatomical success was observed in 84.6% in the group of patients operated with PFCL compared to 52% in the other group (P = 0.005). At the end of the follow up, anatomical success was observed in 64% of patients operated with PFCL compared to 61% in the control group (P = 0.8). However, recurrences were observed later in the group operated on with PFCL. Perfluorocarbons liquids significantly improve the initial reattachment of retinal detachment co...
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