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Majstruk L, Qu-Knafo L, Sarda V, Fajnkuchen F, Nghiem-Buffet S, Grenet T, Chaine G, Giocanti-Auregan A. [Dexamethasone intravitreal implant (Ozurdex) in patients with diabetic macular edema: Real life safety and efficacy]. J Fr Ophtalmol 2020; 43:197-204. [PMID: 32000989 DOI: 10.1016/j.jfo.2019.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 07/29/2019] [Accepted: 08/20/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE The goal of this study was to investigate the safety and efficacy of the intravitreal dexamethasone implant (DI) for patients with diabetic macular edema (DME) in real life. METHODS We conducted a monocentric retrospective analysis of the change in visual acuity and central macular thickness (CMT) after intravitreal injection of the DI at peak efficacy (2 months after injection) as well as the timing of reinjections and complications in patients with a loss of vision due to DME. RESULTS Forty eyes of 33 patients were included, with a mean follow-up of 12.6 months. Thirty percent of the eyes experienced an increase in best corrected visual acuity (BCVA)>15 letters at peak efficacy (P<0.05) after each ID injection. Treatment-naive patients had a sustained response after Ozurdex injection, with better visual acuity at 3 months (P=0.02) and 4 months (P=0.04) than non-naïve patients and better visual acuity at 6 months despite identical baseline visual acuity (P<0.05). Anatomical efficacy was good, with approximately 60% of patients with CMT<300 microns at peak efficacy after each injection of ID. Thirty percent of eyes demonstrated ocular hypertension (OHT)>25mmHg at peak efficacy, and 12.5% of eyes required cataract surgery during follow-up. CONCLUSION The DI has good functional and anatomic efficacy in these patients, with a good safety profile. Treatment-naïve patients with more recent DME had a more sustained increase in visual acuity after the injections and better visual recovery at 6 months. This encourages us to initiate DI therapy early if there is no response to anti-vascular endothelial growth factor (anti-VEGF) treatment.
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Affiliation(s)
- L Majstruk
- Ophthalmology department, Avicenne hospital, DHU Vision and Handicaps, Paris XIII university, 125, rue de Stalingrad, 93000 Bobigny, France
| | - L Qu-Knafo
- Ophthalmology department, Avicenne hospital, DHU Vision and Handicaps, Paris XIII university, 125, rue de Stalingrad, 93000 Bobigny, France
| | - V Sarda
- Ophthalmology department, Avicenne hospital, DHU Vision and Handicaps, Paris XIII university, 125, rue de Stalingrad, 93000 Bobigny, France
| | - F Fajnkuchen
- Ophthalmology department, Avicenne hospital, DHU Vision and Handicaps, Paris XIII university, 125, rue de Stalingrad, 93000 Bobigny, France
| | - S Nghiem-Buffet
- Ophthalmology department, Avicenne hospital, DHU Vision and Handicaps, Paris XIII university, 125, rue de Stalingrad, 93000 Bobigny, France
| | - T Grenet
- Ophthalmology department, Avicenne hospital, DHU Vision and Handicaps, Paris XIII university, 125, rue de Stalingrad, 93000 Bobigny, France
| | - G Chaine
- Ophthalmology department, Avicenne hospital, DHU Vision and Handicaps, Paris XIII university, 125, rue de Stalingrad, 93000 Bobigny, France
| | - A Giocanti-Auregan
- Ophthalmology department, Avicenne hospital, DHU Vision and Handicaps, Paris XIII university, 125, rue de Stalingrad, 93000 Bobigny, France.
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Vo Kim S, Fajnkuchen F, Sarda V, Qu-Knafo L, Bodaghi B, Giocanti-Aurégan A. Sustained intraocular pressure elevation in eyes treated with intravitreal injections of anti-vascular endothelial growth factor for diabetic macular edema in a real-life setting. Graefes Arch Clin Exp Ophthalmol 2017; 255:2165-2171. [PMID: 28831613 DOI: 10.1007/s00417-017-3782-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 08/04/2017] [Accepted: 08/14/2017] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The aim of this study was to investigate the sustained intraocular pressure (IOP) elevation after repeated anti-VEGF intravitreal injections (IVI) in patients with diabetic macular edema (DME). METHODS A retrospective study included 140 eyes without prior glaucoma, treated with at least three anti-VEGF injections for DME between 2012 and 2016. IOP elevation was defined by an increase above baseline IOP by ≥6 mmHg. Baseline IOP was defined as the mean of IOP values before treatment initiation. Three groups were differentiated: group 1 without IOP elevation, groups 2 and 3 with IOP elevation and IOP <21 mmHg (group 2) and ≥21 mmHg (group 3). Rate and several risk factors of IOP elevation were assessed and compared between the three groups. RESULTS IOP elevation occurred in ten eyes (7.1%). IOP was <21 mmHg in six eyes and ≥21 mmHg in four eyes. Statistically significant associations were found between IOP elevation and the number of injections, and HbA1c level. Two patients required local hypotonic treatment. CONCLUSIONS In a real-life setting, we confirmed in eyes with center-involved DME without prior glaucoma or IOP elevation that repeated anti-VEGF IVI may increase the risk of sustained IOP elevation in about 7% of eyes.
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Affiliation(s)
- S Vo Kim
- Ophthalmology Department, Avicenne Hospital, APHP, DHU Vision and Handicaps, Paris 13 University, 125 rue de Stalingrad, 93000, Bobigny, France
| | - F Fajnkuchen
- Ophthalmology Department, Avicenne Hospital, APHP, DHU Vision and Handicaps, Paris 13 University, 125 rue de Stalingrad, 93000, Bobigny, France.,Centre d'imagerie et de Laser, 11 rue Anoine Bourdelle, Paris, France
| | - V Sarda
- Ophthalmology Department, Avicenne Hospital, APHP, DHU Vision and Handicaps, Paris 13 University, 125 rue de Stalingrad, 93000, Bobigny, France
| | - L Qu-Knafo
- Ophthalmology Department, Avicenne Hospital, APHP, DHU Vision and Handicaps, Paris 13 University, 125 rue de Stalingrad, 93000, Bobigny, France
| | - B Bodaghi
- Ophthalmology Department, Avicenne Hospital, APHP, DHU Vision and Handicaps, Paris 13 University, 125 rue de Stalingrad, 93000, Bobigny, France.,Ophthalmology Department, Pitié-Salpétrière Hospital, APHP, DHU Vision and Handicaps, Paris 6 University, Paris, France
| | - A Giocanti-Aurégan
- Ophthalmology Department, Avicenne Hospital, APHP, DHU Vision and Handicaps, Paris 13 University, 125 rue de Stalingrad, 93000, Bobigny, France.
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Vo Kim S, Qu-Knafo L, Giocanti-Aurégan A. [Neovascular sea-fan formation after arteriolar-venular anastomosis in sickle cell retinopathy]. J Fr Ophtalmol 2017; 40:e253-e254. [PMID: 28802686 DOI: 10.1016/j.jfo.2016.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 10/19/2022]
Affiliation(s)
- S Vo Kim
- Service ophtalmologie, hôpital Avicenne, DHU vision et handicaps, 125, rue de Stalingrad, 93000 Bobigny, France
| | - L Qu-Knafo
- Service ophtalmologie, hôpital Avicenne, DHU vision et handicaps, 125, rue de Stalingrad, 93000 Bobigny, France
| | - A Giocanti-Aurégan
- Service ophtalmologie, hôpital Avicenne, DHU vision et handicaps, 125, rue de Stalingrad, 93000 Bobigny, France.
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Herbaut A, Qu-Knafo L, Abad S, Dhote R, Giocanti-Aurégan A. [Bilateral acute arteritic anterior ischemic optic neuropathy during chronic steroid therapy]. J Fr Ophtalmol 2017; 40:e249-e251. [PMID: 28801036 DOI: 10.1016/j.jfo.2016.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/15/2016] [Accepted: 04/18/2016] [Indexed: 11/24/2022]
Affiliation(s)
- A Herbaut
- Service d'ophtalmologie, DHU vision et handicaps, hôpital Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France
| | - L Qu-Knafo
- Service d'ophtalmologie, DHU vision et handicaps, hôpital Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France.
| | - S Abad
- Service de médecine interne, hôpital Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France
| | - R Dhote
- Service de médecine interne, hôpital Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France
| | - A Giocanti-Aurégan
- Service d'ophtalmologie, DHU vision et handicaps, hôpital Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France
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Qu-Knafo L, Auregan-Giocanti A. [Optic disc granuloma secondary to sarcoidosis]. J Fr Ophtalmol 2017; 40:115-117. [PMID: 28094062 DOI: 10.1016/j.jfo.2016.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/13/2016] [Accepted: 08/25/2016] [Indexed: 12/01/2022]
Abstract
We report a case of optic disc granuloma due to sarcoidosis. A 64-year-old, caucasian female with a history of pulmonary sarcoidosis presented with a vision loss on her left eye. The ophthalmologic examination revealed a discrete optic disc infiltrate compatible with the diagnosis of optic disc granuloma. Fluorescein angiography showed diffusion and impregnation of the granuloma without vascularitis. The optical coherence tomography demonstrated a homogenous and isoreflective lesion at the optic disc. The patient recovered her visual acuity after systemic corticosteroid treatment. Isolated optic disc granuloma is a rare condition of ocular sarcoidosis.
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Affiliation(s)
- L Qu-Knafo
- Service d'ophtalmologie, DHU vision et handicaps, hôpital Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France
| | - A Auregan-Giocanti
- Service d'ophtalmologie, DHU vision et handicaps, hôpital Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France.
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Qu-Knafo L, Fajnkuchen F, Sarda V, Nghiem-Buffet S, Chaine G, Giocanti-Auregan A. [French practice patterns in the management of diabetic macular edema]. J Fr Ophtalmol 2016; 39:521-6. [PMID: 27318630 DOI: 10.1016/j.jfo.2016.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 02/16/2016] [Accepted: 02/19/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess French practice patterns in the treatment of diabetic macular edema (DME). METHODS A 31-item survey investigating practice patterns in the diagnosis and management of DME was e-mailed in March 2015 to retina specialist members of the French-speaking Retina Specialist Society. During this time frame, only ranibizumab was reimbursed for this indication. For each question concerning the choice of treatments, respondents were asked to assume that all treatments having market approval were also reimbursed. Answers were analyzed anonymously by Evalandgo software. RESULTS Ninety-five specialists answered the survey. Two thirds of them initiated an intravitreal treatment for DME for a loss of vision greater than 0.5 (Monoyer scale). The three determining factors for treatment choice were potential VA improvement, expected retinal anatomic improvement, and patient availability for monthly follow-up. For central DME in phakic or pseudophakic eyes, the first choice of intravitreal (IVT) treatment was ranibizumab, even assuming that all drugs approved by French authorities (HAS) were reimbursed by the health care system. Eighty-five percent of retinal specialists propose bilateral intravitreal injections the same day for the same patient. CONCLUSION Most of the specialists initiate DME treatment for a VA>0.5 in France. Eighty-five percent of them perform bilateral intravitreal injections on the same day in the case of bilateral DME.
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Affiliation(s)
- L Qu-Knafo
- Service d'ophtalmologie, DHU vision and handicaps, hôpital CHU Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France
| | - F Fajnkuchen
- Service d'ophtalmologie, DHU vision and handicaps, hôpital CHU Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France; Centre ophtalmologique d'imagerie et de laser, 11, rue Antoine-Bourdelle, 75015 Paris, France
| | - V Sarda
- Service d'ophtalmologie, DHU vision and handicaps, hôpital CHU Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France
| | - S Nghiem-Buffet
- Service d'ophtalmologie, DHU vision and handicaps, hôpital CHU Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France; Centre ophtalmologique d'imagerie et de laser, 11, rue Antoine-Bourdelle, 75015 Paris, France
| | - G Chaine
- Service d'ophtalmologie, DHU vision and handicaps, hôpital CHU Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France
| | - A Giocanti-Auregan
- Service d'ophtalmologie, DHU vision and handicaps, hôpital CHU Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France.
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