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Tadayoni R, Massin P, Bonnin S, Magazzeni S, Lay B, Le Guilcher A, Vicaut E, Couturier A, Quellec G, Investigators E. Artificial intelligence-based prediction of diabetic retinopathy evolution (EviRed): protocol for a prospective cohort. BMJ Open 2024; 14:e084574. [PMID: 38626974 PMCID: PMC11029320 DOI: 10.1136/bmjopen-2024-084574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/19/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION An important obstacle in the fight against diabetic retinopathy (DR) is the use of a classification system based on old imaging techniques and insufficient data to accurately predict its evolution. New imaging techniques generate new valuable data, but we lack an adapted classification based on these data. The main objective of the Evaluation Intelligente de la Rétinopathie Diabétique, Intelligent evaluation of DR (EviRed) project is to develop and validate a system assisting the ophthalmologist in decision-making during DR follow-up by improving the prediction of its evolution. METHODS AND ANALYSIS A cohort of up to 5000 patients with diabetes will be recruited from 18 diabetology departments and 14 ophthalmology departments, in public or private hospitals in France and followed for an average of 2 years. Each year, systemic health data as well as ophthalmological data will be collected. Both eyes will be imaged by using different imaging modalities including widefield photography, optical coherence tomography (OCT) and OCT-angiography. The EviRed cohort will be divided into two groups: one group will be randomly selected in each stratum during the inclusion period to be representative of the general diabetic population. Their data will be used for validating the algorithms (validation cohort). The data for the remaining patients (training cohort) will be used to train the algorithms. ETHICS AND DISSEMINATION The study protocol was approved by the French South-West and Overseas Ethics Committee 4 on 28 August 2020 (CPP2020-07-060b/2020-A01725-34/20.06.16.41433). Prior to the start of the study, each patient will provide a written informed consent documenting his or her agreement to participate in the clinical trial. Results of this research will be disseminated in peer-reviewed publications and conference presentations. The database will also be available for further study or development that could benefit patients. TRIAL REGISTRATION NUMBER NCT04624737.
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Affiliation(s)
- Ramin Tadayoni
- Ophthalmology Department, Université Paris Cité, AP-HP, Lariboisiere Hospital, Paris, France
- Ophthalmology Departement, Adolphe de Rothschild Ophthalmological Foundation, Paris, France
| | - Pascale Massin
- Ophthalmology Department, Université Paris Cité, AP-HP, Lariboisiere Hospital, Paris, France
| | - Sophie Bonnin
- Ophthalmology, Adolphe de Rothschild Ophthalmological Foundation, Paris, France
| | | | | | | | - Eric Vicaut
- Assistance Publique-Hopitaux de Paris, Paris, France
| | - Aude Couturier
- Ophthalmology Department, Université Paris Cité, AP-HP, Lariboisiere Hospital, Paris, France
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Creuzot Garcher CP, Massin P, Srour M, Baudin F, Dot C, Nghiem-Buffet S, Girmens JF, Collin C, Ponthieux A, Delcourt C. Management of diabetic macular oedema in France from 2012 to 2018: The nationwide LANDSCAPE study. Acta Ophthalmol 2023. [PMID: 37874253 DOI: 10.1111/aos.15799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVE To describe the management of diabetic macular oedema (DME) patients from the entire French population between 2012 and 2018. METHODS In this retrospective longitudinal study, we identified adults treated for DME from the French population using the exhaustive French National Health Information database (SNDS), and an algorithm based on diagnosis and procedure codes, and reimbursed treatments. RESULTS Between 2012 and 2018, we identified 53 584 treated DME patients, who were followed for up to 7 years from DME treatment initiation. Optical coherence tomography (OCT) became the predominant imaging tool to diagnose DME. Only 14% of patients consulted a diabetologist or endocrinologist in the 3 months prior to initiating DME treatment, whereas 84% consulted a general practitioner. The percentage of patients consulting an ophthalmologist declined over time, from 97% of patients in Year 1 (median of 9 consultations), to 46% in Year 7 (median of 7 consultations). The median DME treatment duration with an anti-VEGF and/or dexamethasone implant treatment was 9 months; 54% of patients had a treatment duration less than 1 year. First-line treatment was more common with ranibizumab (55% of patients) than with aflibercept (30%), or dexamethasone implant (15%). About 25% of patients who initiated anti-VEGF treatment switched treatment at least once, while 30% of patients who initiated dexamethasone implant switched to anti-VEGF treatment at least once. CONCLUSIONS French DME patients seem well-monitored by their ophthalmologist, but median DME treatment duration was just 9 months. These results emphasise the challenge to manage and treat patients with DME over the long term.
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Affiliation(s)
| | - Pascale Massin
- Cabinet d'Ophtalmologie de Breteuil, Hôpital Lariboisière, Paris, France
| | - Mayer Srour
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université de Paris Est Créteil, Créteil, France
| | - Florian Baudin
- Department of Ophthalmology, University Hospital, Dijon, France
| | - Corinne Dot
- Department of Ophthalmology, E.Herriot University Hospital, Lyon, France
| | | | | | | | | | - Cecile Delcourt
- Univ. Bordeaux, Inserm, BPH, U1219, Team LEHA, Bordeaux, France
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Matta S, Lamard M, Conze PH, Le Guilcher A, Lecat C, Carette R, Basset F, Massin P, Rottier JB, Cochener B, Quellec G. Towards population-independent, multi-disease detection in fundus photographs. Sci Rep 2023; 13:11493. [PMID: 37460629 DOI: 10.1038/s41598-023-38610-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/11/2023] [Indexed: 07/20/2023] Open
Abstract
Independent validation studies of automatic diabetic retinopathy screening systems have recently shown a drop of screening performance on external data. Beyond diabetic retinopathy, this study investigates the generalizability of deep learning (DL) algorithms for screening various ocular anomalies in fundus photographs, across heterogeneous populations and imaging protocols. The following datasets are considered: OPHDIAT (France, diabetic population), OphtaMaine (France, general population), RIADD (India, general population) and ODIR (China, general population). Two multi-disease DL algorithms were developed: a Single-Dataset (SD) network, trained on the largest dataset (OPHDIAT), and a Multiple-Dataset (MD) network, trained on multiple datasets simultaneously. To assess their generalizability, both algorithms were evaluated whenever training and test data originate from overlapping datasets or from disjoint datasets. The SD network achieved a mean per-disease area under the receiver operating characteristic curve (mAUC) of 0.9571 on OPHDIAT. However, it generalized poorly to the other three datasets (mAUC < 0.9). When all four datasets were involved in training, the MD network significantly outperformed the SD network (p = 0.0058), indicating improved generality. However, in leave-one-dataset-out experiments, performance of the MD network was significantly lower on populations unseen during training than on populations involved in training (p < 0.0001), indicating imperfect generalizability.
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Affiliation(s)
- Sarah Matta
- Université de Bretagne Occidentale, Brest, Bretagne, France.
- INSERM, UMR 1101, Brest, F-29 200, France.
| | - Mathieu Lamard
- Université de Bretagne Occidentale, Brest, Bretagne, France
- INSERM, UMR 1101, Brest, F-29 200, France
| | - Pierre-Henri Conze
- INSERM, UMR 1101, Brest, F-29 200, France
- IMT Atlantique, Brest, F-29200, France
| | | | - Clément Lecat
- Evolucare Technologies, Villers-Bretonneux, F-80800, France
| | | | - Fabien Basset
- Evolucare Technologies, Villers-Bretonneux, F-80800, France
| | - Pascale Massin
- Service d'Ophtalmologie, Hôpital Lariboisière, APHP, Paris, F-75475, France
| | - Jean-Bernard Rottier
- Bâtiment de consultation porte 14 Pôle Santé Sud CMCM, 28 Rue de Guetteloup, Le Mans, F-72100, France
| | - Béatrice Cochener
- Université de Bretagne Occidentale, Brest, Bretagne, France
- INSERM, UMR 1101, Brest, F-29 200, France
- Service d'Ophtalmologie, CHRU Brest, Brest, F-29200, France
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Feldman-Billard S, Massin P, Creuzot-Garcher C. Comment on Lundeen et al. Trends in the Prevalence and Treatment of Diabetic Macular Edema and Vision-Threatening Diabetic Retinopathy Among Commercially Insured Adults Aged <65 Years. Diabetes Care 2023;46:687-696. Diabetes Care 2023; 46:e138-e139. [PMID: 37339344 DOI: 10.2337/dc23-0588] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 06/22/2023]
Affiliation(s)
- Sylvie Feldman-Billard
- 1Department of Internal Medicine, Centre Hospitalier National d'Ophtalmologie des 15-20, Paris, France
| | - Pascale Massin
- 2Centre Ophtalmologie Breteuil, Centre Broca, Hôpital Lariboisière, Paris, France
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Matta S, Hassine MB, Lecat C, Borderie L, Guilcher AL, Massin P, Cochener B, Lamard M, Quellec G. Federated Learning for Diabetic Retinopathy Detection in a Multi-center Fundus Screening Network. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-4. [PMID: 38082571 DOI: 10.1109/embc40787.2023.10340772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Federated learning (FL) is a machine learning framework that allows remote clients to collaboratively learn a global model while keeping their training data localized. It has emerged as an effective tool to solve the problem of data privacy protection. In particular, in the medical field, it is gaining relevance for achieving collaborative learning while protecting sensitive data. In this work, we demonstrate the feasibility of FL in the development of a deep learning model for screening diabetic retinopathy (DR) in fundus photographs. To this end, we conduct a simulated FL framework using nearly 700,000 fundus photographs collected from OPHDIAT, a French multi-center screening network for detecting DR. We develop two FL algorithms: 1) a cross-center FL algorithm using data distributed across the OPHDIAT centers and 2) a cross-grader FL algorithm using data distributed across the OPHDIAT graders. We explore and assess different FL strategies and compare them to a conventional learning algorithm, namely centralized learning (CL), where all the data is stored in a centralized repository. For the task of referable DR detection, our simulated FL algorithms achieved similar performance to CL, in terms of area under the ROC curve (AUC): AUC =0.9482 for CL, AUC = 0.9317 for cross-center FL and AUC = 0.9522 for cross-grader FL. Our work indicates that the FL algorithm is a viable and reliable framework that can be applied in a screening network.Clinical relevance- Given that data sharing is regarded as an essential component of modern medical research, achieving collaborative learning while protecting sensitive data is key.
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Glacet-Bernard A, Girmens JF, Kodjikian L, Delcourt C, Fajnkuchen F, Creuzot-Garcher C, San Nicolas N, Massin P. Real-World Outcomes of Ranibizumab Treatment in French Patients with Visual Impairment due to Macular Edema Secondary to Retinal Vein Occlusion: 24-Month Results from the BOREAL-RVO Study. Ophthalmic Res 2023; 66:824-834. [PMID: 36972579 DOI: 10.1159/000530294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/10/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Information about real-world ranibizumab use is needed to optimize treatment of macular edema secondary to retinal vein occlusion (RVO). The BOREAL-RVO study assessed treatment use, effectiveness, and safety of 24-month treatment with ranibizumab 0.5 mg in patients with visual impairment due to macular edema secondary to RVO in a real-world setting. METHODS This was a multicenter, post-authorization, observational study in France, including patients starting ranibizumab for RVO. Primary endpoint was mean change from baseline in best-corrected visual acuity (BCVA) at month 6. Secondary endpoints were mean changes from baseline in BCVA at month 24 and central retinal thickness (CRT) at months 6 and 24, and treatment use in real-world setting. RESULTS 226 branch RVO (BRVO) and 196 central RVO (CRVO) patients were enrolled; 71.7% and 70.9% completed the 24-month follow-up, respectively. In BRVO, mean (SD) baseline BCVA was 55.2 (18.7) letters, with gains of 14.3 (13.7), 14.1 (16.5), 13.0 (17.5), and 11.4 (20.1) letters at months 3, 6, 12, and 24, respectively. In CRVO, mean (SD) baseline BCVA was 40.4 (25.6) letters, with gains of 16.0 (21.2), 9.5 (25.4), 9.2 (27.7), and 8.3 (23.8) letters at months 3, 6, 12, and 24, respectively. At month 24, 52% of BRVO and 41% of CRVO patients had gains of 15 or more letters. In BRVO, mean (SD) CRT values at baseline and months 3, 6, 12, and 24 were 550 (175), 315 (104), 343 (122), 335 (137), and 340 (105) μm. In CRVO, mean (SD) CRT values at baseline and months 3, 6, 12, and 24 were 643 (217), 327 (152), 400 (203), 379 (175), and 348 (161) μm. On average, BRVO patients had 3.8 injections for 6.9 visits by month 6, and 7.2 injections for 19.7 visits by month 24. CRVO patients had 2.7 injections for 4.2 visits by month 6 and 7.1 injections for 21.1 visits by month 24. Factors predictive of better BCVA gain at month 6 were age under 60 at baseline, lower baseline BCVA and BCVA gain at month 3. There were no new safety findings. CONCLUSION Major improvements in BCVA and CRT were observed at month 3 after the induction phase and then were sustained up to month 24, with a slight decrease, probably due to under-treatment. This study demonstrated ranibizumab to be a safe and effective treatment for BRVO and CRVO in the real-world setting, although more regular or proactive treatment could further improve outcomes.
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Affiliation(s)
- Agnès Glacet-Bernard
- Department of Ophthalmology/Paris-Est Créteil University (UPEC, Paris XII University)/Intercommunal Hospital Center and Henri Mondor Hospital, Créteil, France
| | - Jean-François Girmens
- Department of Ophthalmology, INSERM-DGOS CIC 1423, Centre Hospitalier National d'Ophtalmologie (CHNO) des Quinze-Vingts, Paris, France
| | - Laurent Kodjikian
- Ophthalmology, Hopital de la Croix Rousse, Lyon University, UMR CNRS MATEIS 5510, Lyon, France
| | - Cécile Delcourt
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team LEHA, UMR 1219, F-33000, Bordeaux, France
| | - Franck Fajnkuchen
- Ophthalmology, Hôpital Avicenne, Bobigny, France
- Centre d'Imagerie et Laser, Paris, France
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Kodjikian L, Delcourt C, Creuzot-Garcher C, Massin P, Conrath J, Velard MÈ, Lassalle T, Pinchinat S, Dupont-Benjamin L. Prospective, Observational, Multicenter, Real-World Study of the Efficacy, Safety, and Pattern of Use of the Dexamethasone Intravitreal Implant in Diabetic Macular Edema in France: Short-Term Outcomes of LOUVRE 3. Ophthalmol Ther 2023; 12:1671-1692. [PMID: 36967448 PMCID: PMC10164204 DOI: 10.1007/s40123-023-00662-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 01/19/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION To evaluate real-world efficacy, safety, and treatment patterns with the dexamethasone intravitreal implant (DEX) in diabetic macular edema (DME) in France. METHODS In this prospective, multicenter, observational, noncomparative, post-reimbursement study, consecutively enrolled patients with DME had a baseline evaluation on day 0. Those treated with DEX on day 0 were to be reevaluated at week 6 and months 6, 12, 18, and 24. DEX retreatment and/or alternative therapies were allowed during follow-up. The primary outcome measure was the maximum best corrected visual acuity (BCVA) gain from baseline during follow-up. Secondary outcome measures included time to maximum BCVA gain, patients (%) with prespecified BCVA gains from baseline at each visit, maximum central retinal thickness (CRT) reduction from baseline, patients (%) with CRT reduction ≥ 20% from baseline at each visit, patients (%) with DME resolution (per investigator judgement), and adverse events (AEs). RESULTS Of 112 patients/eyes with DME for 3.5 years (mean) at baseline, 80 (including 86.1% previously treated) received DEX on day 0 and were analyzed for efficacy. Early study termination precluded collection of ≥ 12-month efficacy data. Patients received 1.4 DEX injections over 8.3 months (averages). The maximum BCVA gain from baseline was 3.6 letters, reached after 77.2 days (averages); 24.6% (week 6) and 15.0% (month 6) of patients experienced ≥ 10-letter BCVA gains from baseline. The mean maximum CRT reduction from baseline was -146.4 µm; 61.4% (week 6) and 36.0% (month 6) of patients had CRT reductions ≥ 20% from baseline, and 68.1% reported DME resolution at least once during follow-up. Ocular hypertension (n = 8, 12.1%) was the most frequent treatment-related AE. CONCLUSIONS LOUVRE 3 confirmed that DEX improves BCVA and CRT, even in a patient population that had predominantly received DEX before enrollment in the study, and showed that DME resolution was observed during follow-up. DEX tolerability was consistent with published data, supporting treatment benefits in DME. CLINICALTRIALS GOV IDENTIFIER NCT03003416.
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Affiliation(s)
- Laurent Kodjikian
- La Croix-Rousse Hospital, University Hospital of Lyon, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France.
- UMR CNRS 5510 MATEIS INSA Lyon, Université de Lyon Claude Bernard, Lyon, France.
| | - Cécile Delcourt
- Université de Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | | | - Pascale Massin
- Centre Hospitalier de L'Université de Lariboisière, Paris, France
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Niqueux É, Flodrops M, Allée C, Lebras MO, Pierre I, Louboutin K, Guillemoto C, Le Prioux A, Le Bouquin-Leneveu S, Keïta A, Amelot M, Martenot C, Massin P, Cherbonnel-Pansart M, Briand FX, Schmitz A, Cazaban C, Dauphin G, Delquigny T, Lemière S, Watier JM, Mogler M, Tarpey I, Grasland B, Eterradossi N. Evaluation of three hemagglutinin-based vaccines for the experimental control of a panzootic clade 2.3.4.4b A(H5N8) high pathogenicity avian influenza virus in mule ducks. Vaccine 2023; 41:145-158. [PMID: 36411134 DOI: 10.1016/j.vaccine.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/01/2022] [Revised: 10/17/2022] [Accepted: 11/06/2022] [Indexed: 11/19/2022]
Abstract
In France during winter 2016-2017, 487 outbreaks of clade 2.3.4.4b H5N8 subtype high pathogenicity (HP) avian influenza A virus (AIV) infections were detected in poultry and captive birds. During this epizootic, HPAIV A/decoy duck/France/161105a/2016 (H5N8) was isolated and characterized in an experimental infection transmission model in conventional mule ducks. To investigate options to possibly protect such ducks against this HPAIV, three vaccines were evaluated in controlled conditions. The first experimental vaccine was derived from the hemagglutinin gene of another clade 2.3.4.4b A(H5N8) HPAIV. It was injected at three weeks of age, either alone (Vac1) or after a primer injection at day-old (Vac1 + boost). The second vaccine (Vac2) was a commercial bivalent adjuvanted vaccine containing an expressed hemagglutinin modified from a clade 2.3.2 A(H5N1) HPAIV. Vac2 was administered as a single injection at two weeks of age. The third experimental vaccine (Vac3) also incorporated a homologous 2.3.4.4b H5 HA gene and was administered as a single injection at three weeks of age. Ducks were challenged with HPAIV A/decoy duck/France/161105a/2016 (H5N8) at six weeks of age. Post-challenge virus excretion was monitored in vaccinated and control birds every 2-3 days for two weeks using real-time reverse-transcription polymerase chain reaction and serological analyses (haemagglutination inhibition test against H5N8, H5 ELISA and AIV ELISA) were performed. Vac1 abolished oropharyngeal and cloacal shedding to almost undetectable levels, whereas Vac3 abolished cloacal shedding only (while partially reducing respiratory shedding) and Vac2 only partly reduced the respiratory and intestinal excretion of the challenge virus. These results provided relevant insights in the immunogenicity of recombinant H5 vaccines in mule ducks, a rarely investigated hybrid between Pekin and Muscovy duck species that has played a critical role in the recent H5 HPAI epizootics in France.
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Affiliation(s)
- Éric Niqueux
- Anses (French Agency for Food, Environmental and Occupational Health & Safety), Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France
| | - Marion Flodrops
- Anses (French Agency for Food, Environmental and Occupational Health & Safety), Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France
| | - Chantal Allée
- Anses (French Agency for Food, Environmental and Occupational Health & Safety), Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France
| | - Marie-Odile Lebras
- Anses (French Agency for Food, Environmental and Occupational Health & Safety), Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France
| | - Isabelle Pierre
- Anses (French Agency for Food, Environmental and Occupational Health & Safety), Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France
| | - Katell Louboutin
- Anses (French Agency for Food, Environmental and Occupational Health & Safety), Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France
| | - Carole Guillemoto
- Anses (French Agency for Food, Environmental and Occupational Health & Safety), Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France
| | - Aurélie Le Prioux
- Anses (French Agency for Food, Environmental and Occupational Health & Safety), Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France
| | - Sophie Le Bouquin-Leneveu
- Anses (French Agency for Food, Environmental and Occupational Health & Safety), Ploufragan-Plouzané-Niort Laboratory, Epidemiology Health and Welfare Unit, BP53, 22440 Ploufragan, France
| | - Alassane Keïta
- Anses (French Agency for Food, Environmental and Occupational Health & Safety), Ploufragan-Plouzané-Niort Laboratory, Avian Experimentation and Breeding Service, BP53, 22440 Ploufragan, France
| | - Michel Amelot
- Anses (French Agency for Food, Environmental and Occupational Health & Safety), Ploufragan-Plouzané-Niort Laboratory, Avian Experimentation and Breeding Service, BP53, 22440 Ploufragan, France
| | - Claire Martenot
- Anses (French Agency for Food, Environmental and Occupational Health & Safety), Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France
| | - Pascale Massin
- Anses (French Agency for Food, Environmental and Occupational Health & Safety), Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France
| | - Martine Cherbonnel-Pansart
- Anses (French Agency for Food, Environmental and Occupational Health & Safety), Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France
| | - François-Xavier Briand
- Anses (French Agency for Food, Environmental and Occupational Health & Safety), Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France
| | - Audrey Schmitz
- Anses (French Agency for Food, Environmental and Occupational Health & Safety), Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France
| | | | - Gwenaëlle Dauphin
- Ceva Santé Animale, 10 Avenue de la Ballastière, 33500 Libourne, France
| | - Thomas Delquigny
- Boehringer Ingelheim Animal Health, 29 avenue Tony Garnier, 69007 Lyon, France
| | - Stéphane Lemière
- Boehringer Ingelheim Animal Health, 29 avenue Tony Garnier, 69007 Lyon, France
| | - Jean-Marie Watier
- MSD Santé Animale, 7 rue Olivier de Serres, BP 17144, 49071 Beaucouzé Cedex, France
| | - Mark Mogler
- Merck Animal Health, Ames, IA 50010, United States of America
| | - Ian Tarpey
- MSD Animal Health, Walton Manor, Milton Keynes MK7 7AJ, United Kingdom
| | - Béatrice Grasland
- Anses (French Agency for Food, Environmental and Occupational Health & Safety), Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France.
| | - Nicolas Eterradossi
- Anses (French Agency for Food, Environmental and Occupational Health & Safety), Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France
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Baillif S, Staccini P, Weber M, Delyfer MN, Le Mer Y, Gualino V, Collot L, Merite PY, Creuzot-Garcher C, Kodjikian L, Massin P. Management of Patients with Diabetic Macular Edema Switched from Dexamethasone Intravitreal Implant to Fluocinolone Acetonide Intravitreal Implant. Pharmaceutics 2022; 14:pharmaceutics14112391. [PMID: 36365209 PMCID: PMC9693281 DOI: 10.3390/pharmaceutics14112391] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 09/12/2022] [Revised: 10/13/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022] Open
Abstract
To assess anatomical and functional outcomes after switching from dexamethasone implant (DEXi) to fluocinolone acetonide implant (FAci) in 113 diabetic macular edema eyes, a multicentric retrospective observational study was conducted. Seventy-five eyes (73.5%) were switched 1−8 weeks after their last DEXi. The mean best-corrected visual acuity improved to 59.8 letters at month 4 and remained stable during the follow-up. The mean central macular thickness (CMT) significantly decreased during the follow-up, with a minimum of 320.9 μm at month 3. The baseline CMT was higher in eyes that received the last DEXi >8 weeks versus <8 weeks before the first FAci (p < 0.021). After FAci injection, additional treatments were needed in 37 (32.7%) eyes. A longer diabetes duration (p = 0.009), a longer time between the last DEXi and the first FAci (p = 0.035), and a high baseline CMT (p = 0.003) were risk factors for additional treatments. The mean intraocular pressure was <19 mmHg at all timepoints, with no difference between eyes receiving the last DEXi ≤8 weeks or >8 weeks before the switch. Switching from DEXi to FAci in DME is effective and safe. A short time between the last DEXi and the first FAci reduced CMT fluctuations and the need for early additional treatments.
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Affiliation(s)
- Stéphanie Baillif
- Department of Ophthalmology, Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 30 Voie Romaine, 06000 Nice, France
- INSERM DR2 U1065, C3M, 151 Avenue Saint-Antoine de Ginestière, 06024 Nice, France
- Correspondence:
| | - Pascal Staccini
- Research Unit RETINES (Risks, Epidemiology, Territories, Information and Education for Health), Université Côte d’Azur, Faculté de Médecine, 28 Avenue de Valombrose, CEDEX 2, 06107 Nice, France
| | - Michel Weber
- Department of Ophthalmology, Centre Hospitalier Universitaire de Nantes, 44000 Nantes, France
| | - Marie-Noëlle Delyfer
- Department of Ophthalmology, Bordeaux University Hospital, 33000 Bordeaux, France
- INSERM, BPH, UMR1219, Bordeaux University, 33000 Bordeaux, France
| | - Yannick Le Mer
- Department of Ophthalmology, A. de Rothschild Ophthalmologic Foundation, 75019 Paris, France
| | - Vincent Gualino
- Clinique Honoré Cave, Department of Ophthalmology, 82000 Montauban, France
- Ophthalmology Department, AP-HP, Hôpital Lariboisière, Université de Paris, 75014 Paris, France
| | - Laurence Collot
- Centre Médico-Chirurgical de Chaumont, 17 Avenue des États-Unis, 52000 Chaumont, France
| | - Pierre-Yves Merite
- Centre D’ophtalmologie, 44 Avenue de Lattre de Tassigny, 13090 Aix-en-Provence, France
| | | | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69002 Lyon, France
- UMR-CNRS 5510 Matéis, University of Lyon, 69622 Villeurbanne, France
| | - Pascale Massin
- Ophthalmic Centre of Breteuil, 14 avenue de Breteuil, 75007 Paris, France
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10
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Briand FX, Niqueux E, Schmitz A, Martenot C, Cherbonnel M, Massin P, Busson R, Guillemoto C, Pierre I, Louboutin K, Souchaud F, Allée C, Quenault H, Lucas P, de Wiele AV, Blanchard Y, Eterradossi N, Scoizec A, Bouquin-Leneveu SL, Rautureau S, Lambert Y, Grasland B. Multiple independent introductions of highly pathogenic avian influenza H5 viruses during the 2020-2021 epizootic in France. Transbound Emerg Dis 2022; 69:4028-4033. [PMID: 36161777 PMCID: PMC10092607 DOI: 10.1111/tbed.14711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/01/2022] [Revised: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 02/04/2023]
Abstract
During winter 2020-2021, France and other European countries were severely affected by highly pathogenic avian influenza H5 viruses of the Gs/GD/96 lineage, clade 2.3.4.4b. In total, 519 cases occurred, mainly in domestic waterfowl farms in Southwestern France. Analysis of viral genomic sequences indicated that 3 subtypes of HPAI H5 viruses were detected (H5N1, H5N3, H5N8), but most French viruses belonged to the H5N8 subtype genotype A, as Europe. Phylogenetic analyses of HPAI H5N8 viruses revealed that the French sequences were distributed in 9 genogroups, suggesting 9 independent introductions of H5N8 from wild birds, in addition to the 2 introductions of H5N1 and H5N3.
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Affiliation(s)
- François-Xavier Briand
- Anses, Ploufragan-Plouzané-Niort Laboratory, Ploufragan, France.,French national reference laboratory for avian influenza and Newcastle disease, Ploufragan, France
| | - Eric Niqueux
- Anses, Ploufragan-Plouzané-Niort Laboratory, Ploufragan, France.,French national reference laboratory for avian influenza and Newcastle disease, Ploufragan, France
| | - Audrey Schmitz
- Anses, Ploufragan-Plouzané-Niort Laboratory, Ploufragan, France.,French national reference laboratory for avian influenza and Newcastle disease, Ploufragan, France
| | - Claire Martenot
- Anses, Ploufragan-Plouzané-Niort Laboratory, Ploufragan, France.,French national reference laboratory for avian influenza and Newcastle disease, Ploufragan, France
| | - Martine Cherbonnel
- Anses, Ploufragan-Plouzané-Niort Laboratory, Ploufragan, France.,French national reference laboratory for avian influenza and Newcastle disease, Ploufragan, France
| | - Pascale Massin
- Anses, Ploufragan-Plouzané-Niort Laboratory, Ploufragan, France.,French national reference laboratory for avian influenza and Newcastle disease, Ploufragan, France
| | - Rachel Busson
- Anses, Ploufragan-Plouzané-Niort Laboratory, Ploufragan, France.,French national reference laboratory for avian influenza and Newcastle disease, Ploufragan, France
| | - Carole Guillemoto
- Anses, Ploufragan-Plouzané-Niort Laboratory, Ploufragan, France.,French national reference laboratory for avian influenza and Newcastle disease, Ploufragan, France
| | - Isabelle Pierre
- Anses, Ploufragan-Plouzané-Niort Laboratory, Ploufragan, France.,French national reference laboratory for avian influenza and Newcastle disease, Ploufragan, France
| | - Katell Louboutin
- Anses, Ploufragan-Plouzané-Niort Laboratory, Ploufragan, France.,French national reference laboratory for avian influenza and Newcastle disease, Ploufragan, France
| | - Florent Souchaud
- Anses, Ploufragan-Plouzané-Niort Laboratory, Ploufragan, France.,French national reference laboratory for avian influenza and Newcastle disease, Ploufragan, France
| | - Chantal Allée
- Anses, Ploufragan-Plouzané-Niort Laboratory, Ploufragan, France.,French national reference laboratory for avian influenza and Newcastle disease, Ploufragan, France
| | - Helene Quenault
- Anses, Ploufragan-Plouzané-Niort Laboratory, Ploufragan, France
| | - Pierrick Lucas
- Anses, Ploufragan-Plouzané-Niort Laboratory, Ploufragan, France
| | | | | | | | - Axelle Scoizec
- Anses, Ploufragan-Plouzané-Niort Laboratory, Ploufragan, France
| | | | | | | | - Béatrice Grasland
- Anses, Ploufragan-Plouzané-Niort Laboratory, Ploufragan, France.,French national reference laboratory for avian influenza and Newcastle disease, Ploufragan, France
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11
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Korobelnik JF, Daien V, Faure C, Tadayoni R, Giocanti-Aurégan A, Dot C, Kodjikian L, Massin P. Two-year outcomes of the APOLLON observational study of intravitreal aflibercept monotherapy in France in patients with diabetic macular edema. Sci Rep 2022; 12:18242. [PMID: 36309572 PMCID: PMC9617874 DOI: 10.1038/s41598-022-22838-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/19/2022] [Indexed: 12/31/2022] Open
Abstract
APOLLON (NCT02924311) was a prospective observational study to evaluate the effectiveness of intravitreal aflibercept (IVT-AFL) treatment of diabetic macular edema (DME) over 24 months in routine clinical practice in France. The primary endpoint was mean change from baseline in best-corrected visual acuity (BCVA; Early Treatment Diabetic Retinopathy Study letters) by 12 months, and safety was monitored throughout the study. Of 402 patients enrolled across 61 participating clinics and hospitals in France, 168 patients were followed for at least 24 months and included in the effectiveness analyses (79 treatment-naïve and 89 previously treated). After 24 months of IVT-AFL treatment, the mean (± standard deviation [SD]) change in BCVA from baseline was + 6.5 (± 10.7) letters in treatment-naïve patients (p < 0.001) and + 1.6 (± 17.0) letters in previously treated patients (p = 0.415) from a baseline of 63.8 (± 13.6) and 60.5 (± 16.5) letters. The mean number of IVT-AFL treatments over 24 months was 11.3 (± 4.9) and 11.9 (± 4.7) for treatment-naïve and previously treated patients. This final analysis of the APOLLON study indicated that following 24 months of IVT-AFL treatment in routine clinical practice in France, treatment-naïve patients with DME achieved significant gains in visual acuity and previously treated patients maintained prior visual acuity gains.Trial registration number: NCT02924311.
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Affiliation(s)
- Jean-François Korobelnik
- grid.414263.6Service d’Ophtalmologie, Hôpital Pellegrin, CHU de Bordeaux, Place Amélie Raba Léon, 33000 Bordeaux, France ,grid.412041.20000 0001 2106 639XINSERM, Bordeaux Population Health Research Center, UMR1219, Université de Bordeaux, Bordeaux, France
| | - Vincent Daien
- grid.414130.30000 0001 2151 3479Hôpital Gui De Chauliac, Montpellier, France ,grid.121334.60000 0001 2097 0141INSERM, Université de Montpellier, Montpellier, France
| | - Céline Faure
- Hôpital Privé Saint Martin, Ramsay Générale de Santé, Caen, France
| | - Ramin Tadayoni
- Hôpital Lariboisière, Université de Paris, Hôpital I, AP-HP, Hôpital Fondation Rothschild, Paris, France
| | | | - Corinne Dot
- grid.414010.00000 0000 8943 5457HIA Desgenettes, Lyon, France ,grid.414014.4École du Val de Grâce, Paris, France
| | - Laurent Kodjikian
- grid.413306.30000 0004 4685 6736Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France ,grid.7849.20000 0001 2150 7757UMR-CNRS 5510 Matéis, University of Lyon, Villeurbanne, France
| | - Pascale Massin
- grid.411296.90000 0000 9725 279XCUDC, Hôpital Lariboisière, Paris, France ,Present Address: Centre d’Ophtalmologie Paris, Breteuil, France
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12
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Creuzot-Garcher C, Massin P, Srour M, Baudin F, Dot C, Nghiem-Buffet S, Girmens JF, Collin C, Ponthieux A, Delcourt C. Epidemiology of Treated Diabetes Ocular Complications in France 2008-2018-The LANDSCAPE French Nationwide Study. Pharmaceutics 2022; 14:2330. [PMID: 36365148 PMCID: PMC9697089 DOI: 10.3390/pharmaceutics14112330] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/17/2022] [Accepted: 10/27/2022] [Indexed: 01/27/2024] Open
Abstract
AIM LANDSCAPE aimed to estimate the annual incidence and prevalence of treated diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) between 2008 and 2018. METHODS This French nationwide observational study used data from the French National Health Insurance Databases covering 99% of the French population. Data about healthcare consumption were used to identify adults treated with anti-VEGFs or dexamethasone implants (for DME) and with pan-retinal photocoagulation (for PDR). All French patients newly treated between 2008 and 2018 were included. Incidence and prevalence of treated DME and PDR were estimated for the age-matched general population and the population with diabetes in France. Sociodemographic characteristics and medical history were described in both populations. RESULTS We identified 53,584 treated DME patients and 127,273 treated PDR patients between 2008 and 2018, and 11,901 DME and 11,996 PDR new incident patients in 2018. The treated DME incidence in 2018 was 2.5 per 10,000 in the general population and 37.3 per 10,000 in the population with diabetes. Prevalence in 2018 was 9.5 and 143.7 per 10,000 in the respective populations. Treated PDR incidence in 2018 was 2.3 per 10,000 in the general population and 31.2 per 10,000 in the population with diabetes. Prevalence in 2018 was 19.9 and 270.3 per 10,000 in the respective populations. Incidence and prevalence were not age-dependent. Incidence of treated PDR incidence was relatively stable from 2008-2018. Incidence of treated DME incidence rose from 2012-2018, probably due to widening access to newly available treatments, such as anti-VEGFs. CONCLUSIONS We provide exhaustive nationwide data on the incidence and prevalence of treated diabetic ocular complications in France over a 10-year period.
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Affiliation(s)
| | - Pascale Massin
- Cabinet d’Ophtalmologie de Breteuil, Centre Broca, Hôpital Lariboisière, 75013 Paris, France
| | - Mayer Srour
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université de Paris Est Créteil, 94000 Créteil, France
| | - Florian Baudin
- Department of Ophthalmology, University Hospital, 21000 Dijon, France
| | - Corinne Dot
- Department of Ophthalmology, Desgenettes Military Hospital, 69003 Lyon, France
| | | | - Jean-Francois Girmens
- Department of Ophthalmology, INSERM-DGOS CIC 1423, Centre Hospitalier National d’Ophtalmologie (CHNO) des Quinze-Vingts, 75012 Paris, France
| | | | - Anne Ponthieux
- Novartis Pharma SAS, 8/10 rue Henri Sainte Claire Deville, 92563 Rueil-Malmaison, France
| | - Cecile Delcourt
- Team LEHA, Bordeaux Population Health Research Center, UMR 1219, Institut National de la Santé et de la Recherche Médicale (Inserm), University of Bordeaux, 33000 Bordeaux, France
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13
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Briand FX, Schmitz A, Scoizec A, Allée C, Busson R, Guillemoto C, Quenault H, Lucas P, Pierre I, Louboutin K, Guillou-Cloarec C, Martenot C, Cherbonnel-Pansart M, Thomas R, Massin P, Souchaud F, Blanchard Y, Steensels M, Lambrecht B, Eterradossi N, Le Bouquin S, Niqueux E, Grasland B. Concomitant NA and NS deletion on avian Influenza H3N1 virus associated with hen mortality in France in 2019. Infect Genet Evol 2022; 104:105356. [PMID: 36038008 DOI: 10.1016/j.meegid.2022.105356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
An H3N1 avian influenza virus was detected in a laying hens farm in May 2019 which had experienced 25% mortality in Northern France. The complete sequencing of this virus showed that all segment sequences belonged to the Eurasian lineage and were phylogenetically very close to many of the Belgian H3N1 viruses detected in 2019. The French virus presented two genetic particularities with NA and NS deletions that could be related to virus adaptation from wild to domestic birds and could increase virulence, respectively. Molecular data of H3N1 viruses suggest that these two deletions occurred at two different times.
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14
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Hurand V, Ducloyer J, Baudin F, Aho S, Weber M, Kodjikian L, Devin F, Gabrielle P, Creuzot‐Garcher C, Massin P. IMPACT study: Impact of adherence to anti-VEGF intravitreal injections for macular disease during COVID 19-related confinement in France. Acta Ophthalmol 2022; 101:91-99. [PMID: 35765939 PMCID: PMC9350166 DOI: 10.1111/aos.15206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/23/2022] [Accepted: 06/05/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE The aim of this study was to evaluate the impact of adherence to French coronavirus disease 2019 (COVID 19)-related guidelines for intravitreal injection (IVI) practice on the visual outcomes of patients treated with anti-vascular endothelial growth factor (VEGF) agents for macular diseases during the first lockdown period. METHODS Observational multicentre study including all patients from 18 centres with an IVI initially planned during the lockdown. Visual acuity (VA, ETDRS) was recorded at 1 and 4 months after lockdown. French COVID 19-related guidelines recommended maintaining IVI practice. We defined three groups of patients: A, adherent to guidelines; NA+, non-adherent with delayed IVIs; and NA-, non-adherent without IVIs performed during the lockdown. Risk factors for non-adherence and visual loss were studied. RESULTS A total of 3020 eyes of 3020 patients, aged 77.8 ± 11.6 years, 59.8% women, were included. 59.3% were non-adherent(46.7% NA+, 12.6% NA-). A smaller decrease in VA at 4 months was observed in the A group than the NA+ and NA- group (-0.2 ± 6.7, -0.3 ± 6.9 and -1.5 ± 6.9, respectively [p < 0.001]). Factors associated with non-adherence were in multivariable analysis, older age, hospital practice, low-density population areas, high viral incidence areas, longer intervals between injection and treat and extent protocol. Factors associated with visual loss at 4 months in multivariable analysis were, being in the NA- group, older age, T&E and fixed regimens. CONCLUSION Strict adherence to guidelines was associated with better visual outcome, although most of our patients did not attend as planned. Identification of patients at risk could help in the future in case of a new pandemic lockdown.
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Affiliation(s)
| | | | - Florian Baudin
- Department of OphthalmologyUniversity HospitalDijonFrance,Pathophysiology and Epidemiology of Cerebro‐Cardiovascular Diseases (PEC2)University HospitalDijonFrance
| | - Serge Aho
- Department of EpidemiologyUniversity HospitalDijonFrance
| | - Michel Weber
- Department of OphthalmologyUniversity HospitalNantesFrance
| | - Laurent Kodjikian
- Department of OphthalmologyCroix Rousse University HospitalLyon 4France
| | - François Devin
- Center of Ophthalmology Monticelli ParadisMarseilleFrance
| | - Pierre‐Henry Gabrielle
- Department of OphthalmologyUniversity HospitalDijonFrance,Eye and Nutrition Research GroupGSGA, INRAeBurgundy, DijonFrance
| | - Catherine Creuzot‐Garcher
- Department of OphthalmologyUniversity HospitalDijonFrance,Eye and Nutrition Research GroupGSGA, INRAeBurgundy, DijonFrance
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15
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Lebrize S, Arnould L, Bourredjem A, Busch C, Rehak M, Massin P, Barbosa-Breda J, Lupidi M, Mariotti C, Hamza M, Grise-Dulac A, Gabrielle PH, Baillif S, Creuzot-Garcher C. Intraocular Pressure Changes After Intravitreal Fluocinolone Acetonide Implant: Results from Four European Countries. Ophthalmol Ther 2022; 11:1217-1229. [PMID: 35426623 PMCID: PMC9114211 DOI: 10.1007/s40123-022-00504-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/21/2022] [Indexed: 11/04/2022] Open
Abstract
Introduction The 0.19 mg fluocinolone acetonide (FAc) intravitreal implant delivers a continuous intravitreal corticosteroid dose for the treatment of refractory diabetic macular oedema (DMO). The aim of this study was to assess the impact of an FAc intravitreal implant on intraocular pressure (IOP). Methods We retrospectively collected anonymised data on the patients’ characteristics, DMO treatment, and IOP and IOP-lowering treatments before and after the FAc intravitreal implant between September 2013 and March 2020 in several European centres. Results A total of 221 eyes from 179 patients were included. The mean follow-up duration was 13.4 (± 12.5, range 2.4–33.5) months. Overall, 194 eyes (88.2%) had received an intravitreal dexamethasone injection before the FAc intravitreal implant. For 25 eyes (11.3%) there was a history of glaucoma, and 52 eyes (23.5%) had previous IOP-lowering treatment. Mean IOP before injection was 14.7 (3.4) mmHg and increased to 16.9 (3.7) mmHg 12 months after injection (P < 0.0001). During follow-up, 55 eyes (24.9%) required the addition or initiation of topical IOP-lowering medication, only one patient (0.5%) had laser trabeculoplasty and one patient (0.5%) a minimally invasive glaucoma surgery, and no patient required incisional IOP-lowering surgery. Conclusion The FAc intravitreal implant led to substantial IOP elevation. This elevation was monitored most of the time with addition or initiation of topical IOP-lowering medication. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-022-00504-z.
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Affiliation(s)
- Sarah Lebrize
- Department of Ophthalmology, Dijon University Hospital, 14 Rue Gaffarel, 21000, Dijon, France
| | - Louis Arnould
- Department of Ophthalmology, Dijon University Hospital, 14 Rue Gaffarel, 21000, Dijon, France
| | | | - Catharina Busch
- Department of Ophthalmology, University Hospital, Leipzig, Germany
| | - Matus Rehak
- Department of Ophthalmology, University Hospital, Leipzig, Germany
| | | | - Joao Barbosa-Breda
- Department of Ophthalmology, São João University Hospital, Porto, Portugal
- Cardiovascular R&D Center, Faculty of Medicine of the University of Porto, Porto, Portugal
- Research Group Ophthalmology, Department of Neurosciences, KULeuven, Leuven, Belgium
| | - Marco Lupidi
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Cesare Mariotti
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Mahmoud Hamza
- Department of Ophthalmology, Le Raincy-Montfermeil Hospital, Montfermeil, France
| | - Alice Grise-Dulac
- Department of Ophthalmology, Fondation A. de Rothschild, Paris, France
| | - Pierre-Henry Gabrielle
- Department of Ophthalmology, Dijon University Hospital, 14 Rue Gaffarel, 21000, Dijon, France
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16
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Matta S, Lamard M, Conze PH, Le Guilcher A, Ricquebourg V, Benyoussef AA, Massin P, Rottier JB, Cochener B, Quellec G. Automatic Screening for Ocular Anomalies Using Fundus Photographs. Optom Vis Sci 2022; 99:281-291. [PMID: 34897234 DOI: 10.1097/opx.0000000000001845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Screening for ocular anomalies using fundus photography is key to prevent vision impairment and blindness. With the growing and aging population, automated algorithms that can triage fundus photographs and provide instant referral decisions are relevant to scale-up screening and face the shortage of ophthalmic expertise. PURPOSE This study aimed to develop a deep learning algorithm that detects any ocular anomaly in fundus photographs and to evaluate this algorithm for "normal versus anomalous" eye examination classification in the diabetic and general populations. METHODS The deep learning algorithm was developed and evaluated in two populations: the diabetic and general populations. Our patient cohorts consist of 37,129 diabetic patients from the OPHDIAT diabetic retinopathy screening network in Paris, France, and 7356 general patients from the OphtaMaine private screening network, in Le Mans, France. Each data set was divided into a development subset and a test subset of more than 4000 examinations each. For ophthalmologist/algorithm comparison, a subset of 2014 examinations from the OphtaMaine test subset was labeled by a second ophthalmologist. First, the algorithm was trained on the OPHDIAT development subset. Then, it was fine-tuned on the OphtaMaine development subset. RESULTS On the OPHDIAT test subset, the area under the receiver operating characteristic curve for normal versus anomalous classification was 0.9592. On the OphtaMaine test subset, the area under the receiver operating characteristic curve was 0.8347 before fine-tuning and 0.9108 after fine-tuning. On the ophthalmologist/algorithm comparison subset, the second ophthalmologist achieved a specificity of 0.8648 and a sensitivity of 0.6682. For the same specificity, the fine-tuned algorithm achieved a sensitivity of 0.8248. CONCLUSIONS The proposed algorithm compares favorably with human performance for normal versus anomalous eye examination classification using fundus photography. Artificial intelligence, which previously targeted a few retinal pathologies, can be used to screen for ocular anomalies comprehensively.
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Affiliation(s)
| | | | | | | | | | | | - Pascale Massin
- Ophtalmology Department, Lariboisière Hospital, APHP, Paris, France
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17
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Huneau-Salaün A, Scoizec A, Thomas R, Martenot C, Schmitz A, Pierre I, Allée C, Busson R, Massin P, Briand FX, Guillemoto C, Louboutin K, Souchaud F, Cherbonnel-Pansart M, Niqueux E, Grasland B, Souillard R, Bouquin SL. Avian influenza outbreaks: evaluating the efficacy of cleaning and disinfection of vehicles and transport crates. Poult Sci 2021; 101:101569. [PMID: 34823166 PMCID: PMC8626697 DOI: 10.1016/j.psj.2021.101569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/21/2021] [Accepted: 10/21/2021] [Indexed: 10/25/2022] Open
Abstract
In 2021, France faced large avian influenza outbreaks, like in 2016 and 2017. Controlling these outbreaks required the preventive depopulation of a large number of duck farms. A previous study in 2017 showed that the quality of decontamination of trucks and transport crates used for depopulation was often insufficient. A new study was then set up to evaluate cleaning and disinfection (C&D) of trucks and crates used for duck depopulation and whether practices had changed since 2017. Three methods were used to assess decontamination: 1) detection of avian influenza virus (AIV) genome, 2) visual inspection of cleanliness, and 3) microbial counts, considering that 2 and 3 are commonly used in abattoirs. Another objective of the study was to evaluate the correlation between results obtained with the 3 methods. In 5 abattoirs, 8 trucks and their crates were sampled by swabbing to detect AIV genome by rRT-PCR before and after decontamination. Visual cleanliness scores and coliform counts were also determined on crates after C&D. Trucks and crates were decontaminated according to the abattoirs' protocols. Before C&D, 3 quarters of crates (59/79) and 7 of 8 trucks were positive for AIV genome. C&D procedures were reinforced in 2021 compared to 2017; use of detergent solution and warm water were more common. Nevertheless, 28% of the crates were positive for AIV genome after C&D, despite the fact that cleaning scores and microbiological counts were satisfactory for 84% and 91% of the crates, respectively. No correlation was observed between results for AIV genome detection and results from visual control or from coliform counts. Abattoirs are encouraged to use environmental sampling coupled with AIV genome detection to monitor the quality of cleaning and disinfection of trucks and crates during AI outbreaks. Reinforcement of biosecurity measures at abattoirs is still needed to avoid residual contamination of the equipment and cross-contamination during the decontamination process.
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Affiliation(s)
| | - Axelle Scoizec
- ANSES - Ploufragan-Plouzané-Niort Laboratory, Ploufragan 22440, France
| | - Rodolphe Thomas
- ANSES - Ploufragan-Plouzané-Niort Laboratory, Ploufragan 22440, France
| | - Claire Martenot
- ANSES - Ploufragan-Plouzané-Niort Laboratory, Ploufragan 22440, France
| | - Audrey Schmitz
- ANSES - Ploufragan-Plouzané-Niort Laboratory, Ploufragan 22440, France
| | - Isabelle Pierre
- ANSES - Ploufragan-Plouzané-Niort Laboratory, Ploufragan 22440, France
| | - Chantal Allée
- ANSES - Ploufragan-Plouzané-Niort Laboratory, Ploufragan 22440, France
| | - Rachel Busson
- ANSES - Ploufragan-Plouzané-Niort Laboratory, Ploufragan 22440, France
| | - Pascale Massin
- ANSES - Ploufragan-Plouzané-Niort Laboratory, Ploufragan 22440, France
| | | | - Carole Guillemoto
- ANSES - Ploufragan-Plouzané-Niort Laboratory, Ploufragan 22440, France
| | - Katell Louboutin
- ANSES - Ploufragan-Plouzané-Niort Laboratory, Ploufragan 22440, France
| | - Florent Souchaud
- ANSES - Ploufragan-Plouzané-Niort Laboratory, Ploufragan 22440, France
| | | | - Eric Niqueux
- ANSES - Ploufragan-Plouzané-Niort Laboratory, Ploufragan 22440, France
| | - Béatrice Grasland
- ANSES - Ploufragan-Plouzané-Niort Laboratory, Ploufragan 22440, France
| | - Rozenn Souillard
- ANSES - Ploufragan-Plouzané-Niort Laboratory, Ploufragan 22440, France
| | - Sophie Le Bouquin
- ANSES - Ploufragan-Plouzané-Niort Laboratory, Ploufragan 22440, France
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18
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Zureik A, Julla JB, Erginay A, Vidal-Trecan T, Juddoo V, Gautier JF, Massin P, Tadayoni R, Riveline JP, Couturier A. Prevalence, severity stages, and risk factors of diabetic retinopathy in 1464 adult patients with type 1 diabetes. Graefes Arch Clin Exp Ophthalmol 2021; 259:3613-3623. [PMID: 34264396 DOI: 10.1007/s00417-021-05298-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/16/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To determine the prevalence of diabetic retinopathy (DR) and its risk factors in adult type 1 diabetes (T1D) patients METHODS: In this cross-sectional study, all T1D patients followed in the University Center for Diabetes and its Complications of Lariboisière Hospital (Paris, France) between January 2017 and February 2019 were included. Ophthalmologic and systemic data were collected from electronic records. The association between DR (and each grade) and associated factors were estimated by univariate and multivariate analyses using logistic regression models. RESULTS A total of 1464 patients (46.2% of women, mean age: 42.2 ± 15.8 years) were included. The mean hemoglobin A1c (HbA1c) was 7.8 ± 1.7% and the mean diabetes duration was 20.5 ± 13.5 years. DR prevalence was 50.1% (47.4-52.6) and the prevalence of mild, moderate, and severe non-proliferative DR and proliferative DR was 19.1%, 9.4%, 3.9%, and 17.6%, respectively. DR was significantly associated with male gender, an older age, former and current smoking status, a higher BMI, the presence of nephropathy and neuropathy, higher HBA1c, and longer diabetes duration. Patients with HbA1c > 10% had an adjusted odds ratio (OR) of 3.25 (1.77-6.01) of having DR compared to patients with HbA1c < 6.5%. Patients with a diabetes duration > 30 years had an adjusted OR of 24.87 (14.82-42.67) higher of having DR compared to patients with a diabetes duration < 10 years. CONCLUSION In this study, 50.1% of adult T1D patients had DR and 17.6% had proliferative DR. Diabetes duration and HbA1c were major risk factors.
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Affiliation(s)
- Abir Zureik
- University of Paris, Ophthalmology Department, AP-HP, Lariboisière Hospital, F-75010, Paris, France.
| | - Jean-Baptiste Julla
- Department of Diabetology and Endocrinology, Lariboisière Hospital, AP-HP, 2 rue Ambroise Paré, Paris, France. Unité INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, Paris, France. Université de Paris, Paris, France
| | - Ali Erginay
- University of Paris, Ophthalmology Department, AP-HP, Lariboisière Hospital, F-75010, Paris, France
| | - Tiphaine Vidal-Trecan
- Department of Diabetology and Endocrinology, Lariboisière Hospital, AP-HP, 2 rue Ambroise Paré, Paris, France. Unité INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, Paris, France. Université de Paris, Paris, France
| | - Vanessa Juddoo
- Department of Diabetology and Endocrinology, Lariboisière Hospital, AP-HP, 2 rue Ambroise Paré, Paris, France. Unité INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, Paris, France. Université de Paris, Paris, France
| | - Jean-François Gautier
- Department of Diabetology and Endocrinology, Lariboisière Hospital, AP-HP, 2 rue Ambroise Paré, Paris, France. Unité INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, Paris, France. Université de Paris, Paris, France
| | - Pascale Massin
- University of Paris, Ophthalmology Department, AP-HP, Lariboisière Hospital, F-75010, Paris, France
| | - Ramin Tadayoni
- University of Paris, Ophthalmology Department, AP-HP, Lariboisière Hospital, F-75010, Paris, France
| | - Jean-Pierre Riveline
- Department of Diabetology and Endocrinology, Lariboisière Hospital, AP-HP, 2 rue Ambroise Paré, Paris, France. Unité INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, Paris, France. Université de Paris, Paris, France
| | - Aude Couturier
- University of Paris, Ophthalmology Department, AP-HP, Lariboisière Hospital, F-75010, Paris, France.
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19
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Julla JB, Jacquemier P, Fagherazzi G, Vidal-Trecan T, Juddoo V, Jaziri A, Mersel H, Venteclef N, Roussel R, Massin P, Couturier A, Gautier JF, Riveline JP. Is the Consensual Threshold for Defining High Glucose Variability Implementable in Clinical Practice? Diabetes Care 2021; 44:1722-1725. [PMID: 34099517 DOI: 10.2337/dc20-1847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 04/14/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Estimating glycemic variability (GV) through within-day coefficient of variation (%CVw) is recommended for patients with type 1 Diabetes (T1D). High GV (hGV) is defined as %CVw > 36%. However, continuous glucose monitoring (CGM) devices provide exclusively total CV (%CVT). We aimed to assess consequences of this disparity. RESEARCH DESIGN AND METHODS We retrospectively calculated both %CVT and %CVw of consecutive T1D patients from their CGM raw data during 14 days. Patients with hGV with %CVT >36% and %CVw ≤36% were called the "inconsistent GV group". RESULTS A total of 104 patients were included. Mean ± SD %CVT and %CVw were 42.4 ± 8% and 37.0 ± 7.4% respectively (P < 0.0001). Using %CVT, 81 patients (73.6%) were classified as having hGV, whereas 59 (53.6%) using %CVw (P < 0.0001) corresponding to 22 patients (21%) in the inconsistent GV population. CONCLUSIONS Evaluation of GV through %CV in patients with T1D is highly dependent on the calculation method and then must be standardized.
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Affiliation(s)
- Jean-Baptiste Julla
- Department of Diabetology and Endocrinology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.,Unité INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, and Université de Paris, Paris, France
| | - Pauline Jacquemier
- Unité INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, and Université de Paris, Paris, France.,Air Liquide Healthcare Explor Center Medicotechnical, Paris, France
| | - Guy Fagherazzi
- U1018 INSERM/Center for Research in Epidemiology and Population Health, Institut Gustave Roussy, Villejuif, France.,Faculty of Medicine, Paris-South Paris Saclay University, Villejuif, France.,UMR 970 INSERM, Cardiovascular Research Center, University of Paris, Paris, France.,Digital Epidemiology Hub, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Tiphaine Vidal-Trecan
- Department of Diabetology and Endocrinology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Vanessa Juddoo
- Department of Diabetology and Endocrinology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Asma Jaziri
- Department of Diabetology and Endocrinology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Hanane Mersel
- Department of Diabetology and Endocrinology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Nicolas Venteclef
- Unité INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, and Université de Paris, Paris, France
| | - Ronan Roussel
- Unité INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, and Université de Paris, Paris, France.,Department of Diabetology, Endocrinology, and Nutrition, Bichat-Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Pascale Massin
- Ophthalmology Department, Centre Universitaire du Diabète et de ses Complications, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Aude Couturier
- Department of Ophthalmology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris 7 - Sorbonne Paris Cité, Paris, France
| | - Jean-François Gautier
- Department of Diabetology and Endocrinology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.,Unité INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, and Université de Paris, Paris, France
| | - Jean-Pierre Riveline
- Department of Diabetology and Endocrinology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France .,Unité INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, and Université de Paris, Paris, France
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20
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Briand FX, Niqueux E, Schmitz A, Martenot C, Cherbonnel M, Massin P, Kerbrat F, Chatel M, Guillemoto C, Guillou-Cloarec C, Ogor K, Le Prioux A, Allée C, Beven V, Hirchaud E, Blanchard Y, Scoizec A, Le Bouquin S, Eterradossi N, Grasland B. Highly Pathogenic Avian Influenza A(H5N8) Virus Spread by Short- and Long-Range Transmission, France, 2016-17. Emerg Infect Dis 2021; 27:508-516. [PMID: 33496244 PMCID: PMC7853534 DOI: 10.3201/eid2702.202920] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We detected 3 genotypes of highly pathogenic avian influenza A(H5N8) virus in France during winter 2016–17. Genotype A viruses caused dramatic economic losses in the domestic duck farm industry in southwestern France. Our phylogenetic analysis suggests that genotype A viruses formed 5 distinct geographic clusters in southwestern France. In some clusters, local secondary transmission might have been started by a single introduction. The intensity of the viral spread seems to correspond to the density of duck holdings in each production area. To avoid the introduction of disease into an unaffected area, it is crucial that authorities limit the movements of potentially infected birds.
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21
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Kodjikian L, Mehanna CJ, Cohen SY, Devin F, Razavi S, Querques G, Massin P, Coscas F, Souied E. The role of future treatments in the management of neovascular age-related macular degeneration in Europe. Eur J Ophthalmol 2021; 31:2179-2188. [PMID: 34053331 DOI: 10.1177/11206721211018348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anti-vascular endothelial growth factor (VEGF) agents have transformed the management of patients with neovascular age-related macular degeneration (nAMD) over the past two decades. However, as more long-term real-world data become available, it is clear that treatment outcomes are inferior to those reported in large, controlled clinical trials. This is largely driven by undertreatment, that is, not maintaining a consistent injection frequency to achieve sustained VEGF suppression, whether due to patient non-compliance, an important injection burden, or non/incomplete anatomical response. Newer therapeutic advances under evaluation hold promise in achieving more, for less. We review the latest drugs currently in or having successfully finished phase III clinical trials, and determine their potential place in the management of patients with nAMD in Europe.
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Affiliation(s)
- Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Claude Bernard University Lyon 1, Lyon, Rhône-Alpes, France.,UMR-CNRS 5510 Mateis Laboratory, University Lyon 1, Villeurbanne, France
| | - Carl Joe Mehanna
- Intercommunal Hospital of Créteil, Paris-Est University, Créteil, France
| | | | - François Devin
- Center Monticelli-Paradis, Juge Clinic, Marseille, France
| | - Sam Razavi
- St. Exupery Ophthalmic Center, Saint Cyr sur Loire, France
| | - Giuseppe Querques
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Vita-Salute University, Milan, Lombardy, Italy
| | - Pascale Massin
- Ophthalmic Center of Breteuil, Paris, Île-de-France, France
| | | | - Eric Souied
- Intercommunal Hospital of Créteil, Paris-Est University, Créteil, France
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22
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Quellec G, Al Hajj H, Lamard M, Conze PH, Massin P, Cochener B. ExplAIn: Explanatory artificial intelligence for diabetic retinopathy diagnosis. Med Image Anal 2021; 72:102118. [PMID: 34126549 DOI: 10.1016/j.media.2021.102118] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 09/03/2020] [Revised: 03/15/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
In recent years, Artificial Intelligence (AI) has proven its relevance for medical decision support. However, the "black-box" nature of successful AI algorithms still holds back their wide-spread deployment. In this paper, we describe an eXplanatory Artificial Intelligence (XAI) that reaches the same level of performance as black-box AI, for the task of classifying Diabetic Retinopathy (DR) severity using Color Fundus Photography (CFP). This algorithm, called ExplAIn, learns to segment and categorize lesions in images; the final image-level classification directly derives from these multivariate lesion segmentations. The novelty of this explanatory framework is that it is trained from end to end, with image supervision only, just like black-box AI algorithms: the concepts of lesions and lesion categories emerge by themselves. For improved lesion localization, foreground/background separation is trained through self-supervision, in such a way that occluding foreground pixels transforms the input image into a healthy-looking image. The advantage of such an architecture is that automatic diagnoses can be explained simply by an image and/or a few sentences. ExplAIn is evaluated at the image level and at the pixel level on various CFP image datasets. We expect this new framework, which jointly offers high classification performance and explainability, to facilitate AI deployment.
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Affiliation(s)
| | - Hassan Al Hajj
- Univ Bretagne Occidentale, Brest F-29200 France; Inserm, UMR 1101, Brest F-29200 France
| | - Mathieu Lamard
- Univ Bretagne Occidentale, Brest F-29200 France; Inserm, UMR 1101, Brest F-29200 France
| | - Pierre-Henri Conze
- IMT Atlantique, Brest, F-29200 France; Inserm, UMR 1101, Brest F-29200 France
| | - Pascale Massin
- Service d'Ophtalmologie, Hôpital Lariboisière, APHP, Paris F-75475 France
| | - Béatrice Cochener
- Univ Bretagne Occidentale, Brest F-29200 France; Inserm, UMR 1101, Brest F-29200 France; Service d'Ophtalmologie, CHRU Brest, Brest F-29200 France
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23
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Gabrielle P, Massin P, Arnould L, Couturier A, Bouché‐Pillon J, Maupin E, Aho‐Glele S, Bron AM, Kodjikian L, Creuzot‐Garcher C. Development of a 1-year risk-prediction nomogram for good functional response with anti-VEGF agents in naive diabetic macular oedema. Acta Ophthalmol 2020; 98:e975-e982. [PMID: 32268017 DOI: 10.1111/aos.14428] [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: 10/02/2019] [Accepted: 03/12/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To develop a risk-prediction nomogram based on baseline variables for good functional response during the 1st year of treatment with anti-VEGF agents in naive diabetic macular oedema (DME). METHODS This retrospective study included patients presenting naive-DME treated with anti-VEGF therapy at Dijon University Hospital (France) between 1 February 2012 and 31 March 2015 (derivation cohort). We studied baseline variables that had significant associations with a good functional response to anti-VEGF agents during the 1st year of treatment. We used a program to generate a nomogram based on a binary logistic regression predictive model. Then, this nomogram was tested on data from a separate cohort of naive-DME patients from a multicenter study involving 20 French ophthalmologic centres between January 2014 and June 2015 (validation cohort). RESULTS Age, baseline BCVA and ellipsoid zone integrity on spectral-domain optical coherence tomography (SD-OCT) are functional prognostic factors and were used to build a nomogram. The nomogram showed excellent discrimination for good functional responders (area under the curve (AUC) = 0.906, 95% confidence interval (95% CI) = [0.849-0.964], p = 0.004). The discriminative power of this nomogram was tested on the validation cohort data, demonstrating good discrimination of good functional responders (AUC = 0.942, 95% CI = [0.898-0.986], p < 0.001). CONCLUSION This nomogram provides a useful estimation of a good functional response in naive-DME patients treated with anti-VEGF agents.
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Affiliation(s)
- Pierre‐Henry Gabrielle
- Ophthalmology Department University Hospital Dijon France
- Eye and Nutrition Research Group Centre des Sciences du Goût et de l’Alimentation UMR1324 INRA 6265 CNRS University of Bourgogne Franche‐Comté Dijon France
| | - Pascale Massin
- Ophthalmology Department Lariboisière Hospital Assistance Publique des Hôpitaux de Paris Université Paris Diderot Paris France
| | - Louis Arnould
- Ophthalmology Department University Hospital Dijon France
| | - Aude Couturier
- Ophthalmology Department Lariboisière Hospital Assistance Publique des Hôpitaux de Paris Université Paris Diderot Paris France
| | | | - Edouard Maupin
- Ophthalmology Department University Hospital Dijon France
| | | | - Alain M. Bron
- Ophthalmology Department University Hospital Dijon France
- Eye and Nutrition Research Group Centre des Sciences du Goût et de l’Alimentation UMR1324 INRA 6265 CNRS University of Bourgogne Franche‐Comté Dijon France
| | - Laurent Kodjikian
- Ophthalmology Department Lyon la Croix‐Rousse Hospices civils de Lyon Lyon France
| | - Catherine Creuzot‐Garcher
- Ophthalmology Department University Hospital Dijon France
- Eye and Nutrition Research Group Centre des Sciences du Goût et de l’Alimentation UMR1324 INRA 6265 CNRS University of Bourgogne Franche‐Comté Dijon France
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24
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Massin P, Creuzot-Garcher C, Kodjikian L, Girmens JF, Delcourt C, Fajnkuchen F, Glacet-Bernard A, Guillausseau PJ, Guthux F, Blin P, Grelaud A. Real-World Outcomes after 36-Month Treatment with Ranibizumab 0.5 mg in Patients with Visual Impairment due to Diabetic Macular Edema (BOREAL-DME). Ophthalmic Res 2020; 64:577-586. [PMID: 32932257 DOI: 10.1159/000511591] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 09/14/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the efficacy, safety, and follow-up of 36-month treatment with ranibizumab in patients with diabetic macular edema (DME) in real-life setting. METHODS This is a prospective phase 4 observational study. Between December 2013 and April 2015, 84 ophthalmologists enrolled a total of 290 adult patients initiating ranibizumab for visual impairment due to DME and treated them according to their routine practice. The primary outcome (mean change in best-corrected visual acuity [BCVA] after 12 months) was previously reported. Here, we present outcomes after 36 months of follow-up for BCVA and change in central subfield thickness (CSFT) and report how participating ophthalmologists treated DME over a 3-year period (number of visits and injections and evolution of treatment strategy). RESULTS Of the 290 patients enrolled, 187 (64.5%) completed the 36 months of the study (entire cohort). In the entire cohort, 97 patients were treated exclusively with ranibizumab throughout the study, and 90 patients switched to other intravitreal treatments. Mean BCVA was 64.2 (20.1) letters, representing a gain of +4.1 (19.9) letters from baseline to month 36 (M36). CSFT improved over the study, and by M36 had decreased by 127 (138) µm compared to baseline. Over the 36 months of follow-up, patients in the entire cohort paid their ophthalmologists a mean of 30.9 (12.2) visits and had a mean of 7.6 (5.2) any injections. Results for quality of life questionnaires NEI-VFQ25 and HUI-3 remained stable throughout the study. Multivariate analysis on the 145 patients with evaluable BCVA data at M36 found that male gender and milder baseline DME characteristics (BCVA ≥59 and CSFT <500 µm) were predictive factors for achieving a BCVA of ≥70 letters at M36. This study did not find any new safety signals, compared to the known profile of ranibizumab. CONCLUSIONS Gains in BCVA in this real-life study were lower than those observed in randomized clinical trials with ranibizumab, mainly due to undertreatment. Safety analysis of ranibizumab did not yield any new safety concerns.
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Affiliation(s)
- Pascale Massin
- Ophthalmology, APHP Lariboisiere, Centre Breteuil, Paris, France
| | | | - Laurent Kodjikian
- Ophthalmology, Hopital de la Croix Rousse, Lyon University, UMR CNRS MATEIS 5510, Lyon, France
| | | | - Cécile Delcourt
- Inserm, Bordeaux Population Health Research Center, Team LEHA, UMR 1219, University of Bordeaux, Bordeaux, France
| | - Franck Fajnkuchen
- Ophthalmology, Hôpital Avicenne, Bobigny, France.,Centre d'Imagerie et Laser, Paris, France
| | - Agnès Glacet-Bernard
- Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Paris-Est Créteil University, Créteil, France
| | | | | | - Patrick Blin
- Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, Bordeaux, France
| | - Angela Grelaud
- Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, Bordeaux, France
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25
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Massin P, Guillou-Cloarec C, Martenot C, Niqueux E, Schmitz A, Briand FX, Allée C, Guillemoto C, Lebras MO, Le Prioux A, Ogor K, Eterradossi N. Highly Pathogenic Avian Influenza H5N1 A/Chicken/France/150169a/2015 Presents In Vitro Characteristics Consistent with Its Predicted Tropism for Avian Species. Avian Dis 2020; 64:85-91. [PMID: 32267129 DOI: 10.1637/0005-2086-64.1.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/30/2019] [Accepted: 10/17/2019] [Indexed: 11/05/2022]
Abstract
Avian influenza A viruses are a major threat to animal and public health. Since 1997, several highly pathogenic H5N1 avian viruses have been directly transmitted from poultry to humans, caused numerous human deaths, and had considerable economic impact on poultry markets. During 2015-2016, a highly pathogenic avian influenza outbreak occurred in southwestern France. Different subtypes circulated, including the A/chicken/France/150169a/2015 H5N1 highly pathogenic virus, which did not possess the full set of genomic determinants known to promote transmission to humans. In order to evaluate the predicted absence of zoonotic potential, a quick method based on in vitro tests was developed to analyze some genetic and phenotypic host restriction determinants. A receptor-binding assay showed that the virus preferentially recognizes avian cell receptors. Temperature sensitivity revealed a cold-sensitive phenotype of the virus at 33 C as virus replication was reduced in contrast with what is expected for human influenza viruses, according to their primary infection sites. Altogether, our quick evaluation method suggests that the A/chicken/France/150169a/2015 H5N1 highly pathogenic virus has an avian phenotype in vitro, in accordance with in silico predictions based on genomic markers.
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Affiliation(s)
- Pascale Massin
- Anses, Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France,
| | - Cécile Guillou-Cloarec
- Anses, Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France
| | - Claire Martenot
- Anses, Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France
| | - Eric Niqueux
- Anses, Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France
| | - Audrey Schmitz
- Anses, Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France
| | - François-Xavier Briand
- Anses, Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France
| | - Chantal Allée
- Anses, Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France
| | - Carole Guillemoto
- Anses, Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France
| | - Marie-Odile Lebras
- Anses, Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France
| | - Aurélie Le Prioux
- Anses, Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France
| | - Katell Ogor
- Anses, Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France
| | - Nicolas Eterradossi
- Anses, Ploufragan-Plouzané-Niort Laboratory, Avian and Rabbit Virology Immunology and Parasitology Unit, National Reference Laboratory for Avian Influenza, BP53, 22440 Ploufragan, France
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Couturier A, Giocanti-Auregan A, Massin P. [Treatment switch in diabetic macular edema: Literature review and management algorithm]. J Fr Ophtalmol 2020; 43:710-717. [PMID: 32653096 DOI: 10.1016/j.jfo.2019.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 10/07/2019] [Revised: 11/21/2019] [Accepted: 12/27/2019] [Indexed: 12/01/2022]
Abstract
Initial management of diabetic macular edema (DME) is well-defined, but there is a lack of national or international consensus for patients who do not respond or respond only partially to these treatments. Several studies, mostly retrospective, have assessed medication switches, but currently, the literature contains no randomized studies. The goal of this article is to present an algorithm for switching medications, which can be proposed to DME patients treated with anti-VEGF agents, as defined by a group of French retina experts, supported by the existing literature on the subject. After initiation of an anti-VEGF treatment for DME, the response is usually assessed after 5 monthly injections. A partial anatomical response (reduction of central retinal thickness between 10 and 20%), seen in 30 to 40% of patients, is associated with a favorable visual prognosis according to randomized studies. Continuation of the anti-VEGF injections after the induction phase is thus possible. If the response remains incomplete after 3 additional anti-VEGF injections, a complete ophthalmologic examination should be performed, and a switch to another therapeutic class (corticosteroids) may be proposed in the absence of contraindications. If a complete non-response is seen initially (reduction of central retinal thickness<10%), the switch is proposed immediately after the induction phase.
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Affiliation(s)
- A Couturier
- Service d'ophtalmologie, hôpital Lariboisière, université de Paris, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - A Giocanti-Auregan
- Service d'ophtalmologie, hôpital Avicenne, DHU vision et handicaps, université Paris, 13, AP-HP, Bobigny, France
| | - P Massin
- Centre d'ophtalmologie Breteuil, centre Broca, hôpital Lariboisière, Paris, France
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27
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Abstract
Conservative treatments for aseptic osteonecrosis of the femoral head have their ancestor in the core decompression of the femoral neck, recommended by Ficat. Due to inconsistent results, this treatment has been optimized by either vascularized fibular grafting, or by injecting autologous stem cells into the necrotic zone. The French promoters have published long-term results, showing efficacy in the early stages of the disease, where the femoral head has not yet lost its sphericity. Over the last 10years, comparative studies, sometimes randomized, opposing them to simple core decompression, have been published by non-promoters, confirming the possibility of stabilization or even regression of necrosis area. But these techniques are not easy to implement. Cell therapy requires treatment of marrow samples by centrifugation to obtain a pellet with a high concentration of haematopoietic cells. The now proven long-term efficacy as well as the safety of this technique make it the method of choice for treating young patients detected at the sub-radiological stage by MRI. Unfortunately, many are seen late with detached cephalic cartilage or collapsed femoral head and have no other option than total hip arthroplasty. This technique is very reliable. With alumina ceramics, results of more than 20years show the absence of wear and osteolysis, although other complications such as instability or periprosthetic fractures may occur in these young and active patients.
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Affiliation(s)
- P Massin
- CMC Ambroise-Paré-Hartmann, 3, rue de l'Hôtel-de-Ville, 92200 Neuilly-sur-Seine, France.
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28
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Chamard C, Daien V, Erginay A, Gautier JF, Villain M, Tadayoni R, Carriere I, Massin P. Ten-year incidence and assessment of safe screening intervals for diabetic retinopathy: the OPHDIAT study. Br J Ophthalmol 2020; 105:432-439. [PMID: 32522790 DOI: 10.1136/bjophthalmol-2020-316030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 02/10/2020] [Revised: 04/23/2020] [Accepted: 05/14/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND To estimate the 10-year incidence of referable diabetic retinopathy (DR) in a French population with type 1 and 2 diabetes mellitus (DM). A secondary objective was the assessment of safe screening intervals in patients with diabetes without retinopathy. METHODS Observational, prospective and multicentric study between June 2004 and September 2017 based on a regional screening programme for DR in the Paris region. The incidence of referable DR in patients without retinopathy at baseline was calculated by the Turnbull survival estimator. A safe screening interval was defined as a 95% probability of remaining without referable DR. RESULTS Among the 25 745 participants with type 1 (n=6086) or type 2 (n=19 659) DM, the 10-year cumulative incidence of referable DR was 19.10% (95% CI 17.21% to 21.14%) and 17.03% (15.78% to 18.35%), median (IQR) follow-up=3.33 (4.24) years. The safe screening interval for patients without DR at the first examination for type 1 and 2 DM was 2.2 (95% CI 2.0 to 2.4) and 3.0 (2.9 to 3.1) years, respectively. In a subgroup of low-risk patients with type 2 DM, the safe screening interval was 4.2 (3.8 to 4.6) years. CONCLUSIONS These data suggest that in Paris area, a 2-year, 3-year and 4-year screening interval was considered safe for type 1 DM, type 2 DM and for low-risk patients with type 2 DM, respectively, without DR at the first examination. While these data might be used to support the consideration of extending screening intervals, a randomised clinical trial would be suitable to confirm the safety for patients with DM.
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Affiliation(s)
- Chloé Chamard
- Ophthalmology, University Hospital Montpellier, Montpellier, France.,Univ. Montpellier, Inserm, Neuropsychiatry: epidemiological and clinical research, PSNREC, Montpellier, France
| | - Vincent Daien
- Ophthalmology, University Hospital Montpellier, Montpellier, France .,Univ. Montpellier, Inserm, Neuropsychiatry: epidemiological and clinical research, PSNREC, Montpellier, France
| | - Ali Erginay
- Ophthalmology Department, Assistance Publique des Hôpitaux de Paris, Paris, France
| | | | - Max Villain
- Ophthalmology, University Hospital Montpellier, Montpellier, France
| | - Ramin Tadayoni
- Ophthalmology Department, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Isabelle Carriere
- Univ. Montpellier, Inserm, Neuropsychiatry: epidemiological and clinical research, PSNREC, Montpellier, France
| | - Pascale Massin
- Ophthalmology Department, Assistance Publique des Hôpitaux de Paris, Paris, France
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Hernández C, Porta M, Bandello F, Grauslund J, Harding SP, Aldington SJ, Egan C, Frydkjaer-Olsen U, García-Arumí J, Gibson J, Lang GE, Lattanzio R, Massin P, Midena E, Ponsati B, Ribeiro L, Scanlon P, Cunha-Vaz J, Simó R. The Usefulness of Serum Biomarkers in the Early Stages of Diabetic Retinopathy: Results of the EUROCONDOR Clinical Trial. J Clin Med 2020; 9:jcm9041233. [PMID: 32344735 PMCID: PMC7231127 DOI: 10.3390/jcm9041233] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 12/22/2022] Open
Abstract
The main aim of this study was to evaluate the ability of serum biomarkers to predict the worsening of retinal neurodysfunction in subjects with type 2 diabetes. For this purpose, we measured selected molecules (N-epsilon-carboxy methyl lysine (CML), laminin P1 (Lam-P1), and asymmetric dimethylarginine (ADMA)) in the serum of 341 participants of the EUROCONDOR study at baseline, 24, and 48 weeks. Retinal neurodysfunction was assessed by measuring implicit time (IT) using multifocal electroretinography, and structural changes were examined by spectral domain–optical coherence tomography. The values of IT at baseline were directly correlated with baseline serum concentrations of CML (r = 0.135, p = 0.013). Furthermore, in the placebo group, increase in CML concentration throughout follow-up correlated with the IT (r = 0.20; p = 0.03). Baseline serum levels of CML also correlated with macular retinal thickness (RT) (r = 0.231; p < 0.001). Baseline Lam-P1 levels correlated with the increase of the RT at the end of follow-up in the placebo group (r = 0.22; p = 0.016). We provide evidence that CML may be a biomarker of both retinal neurodysfunction and RT, whereas Lam-P1 was associated with RT only. Therefore, circulating levels of these molecules could provide a complementary tool for monitoring the early changes of diabetic retinopathy (DR).
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Affiliation(s)
- Cristina Hernández
- Diabetes and Metabolism Research Unit and CIBERDEM, Vall d’Hebron Research Institute, 08035 Barcelona, Spain;
- Correspondence:
| | - Massimo Porta
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy;
| | - Francesco Bandello
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, 20132 Milano, Italy; (F.B.); (R.L.)
| | - Jakob Grauslund
- Research Unit of Ophthalmology, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark; (J.G.); (U.F.-O.)
| | - Simon P. Harding
- Department of Eye & Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, and St. Pauls’ Eye Unit. Liverpool University Hospitals, members of Liverpool Health Partners, Liverpool L69 7ZX, UK;
| | - Stephen J. Aldington
- Gloucestershire Hospitals National Health Service Foundation Trust, Cheltenham GL53 7AG, UK; (S.J.A.); (P.S.)
| | - Catherine Egan
- Moorfields Eye Hospital National Health Service Foundation Trust, Institute of Ophthalmology/University College London, London EC1V 2PD, UK;
| | - Ulrik Frydkjaer-Olsen
- Research Unit of Ophthalmology, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark; (J.G.); (U.F.-O.)
| | - José García-Arumí
- Department of Ophthalmology, Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
| | - Jonathan Gibson
- Department of Vision Sciences, Aston University, Birmingham B4 7ET, UK;
| | - Gabriele E. Lang
- Department of Ophthalmology, University of Ulm, 89081 Ulm, Germany;
| | - Rosangela Lattanzio
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, 20132 Milano, Italy; (F.B.); (R.L.)
| | - Pascale Massin
- Department of Ophthalmology, Lariboisière Hospital, 75004 Paris, France;
| | - Edoardo Midena
- Department of Ophthalmology, University of Padova, 35122 Padova, Italy;
| | | | - Luísa Ribeiro
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), 3000-548 Coimbra, Portugal; (L.R.); (J.C.-V.)
| | - Peter Scanlon
- Gloucestershire Hospitals National Health Service Foundation Trust, Cheltenham GL53 7AG, UK; (S.J.A.); (P.S.)
| | - José Cunha-Vaz
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), 3000-548 Coimbra, Portugal; (L.R.); (J.C.-V.)
| | - Rafael Simó
- Diabetes and Metabolism Research Unit and CIBERDEM, Vall d’Hebron Research Institute, 08035 Barcelona, Spain;
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30
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Gaborit B, Julla JB, Besbes S, Proust M, Vincentelli C, Alos B, Ancel P, Alzaid F, Garcia R, Mailly P, Sabatier F, Righini M, Gascon P, Matonti F, Houssays M, Goumidi L, Vignaud L, Guillonneau X, Erginay A, Dupas B, Marie-Louise J, Autié M, Vidal-Trecan T, Riveline JP, Venteclef N, Massin P, Muller L, Dutour A, Gautier JF, Germain S. Glucagon-like Peptide 1 Receptor Agonists, Diabetic Retinopathy and Angiogenesis: The AngioSafe Type 2 Diabetes Study. J Clin Endocrinol Metab 2020; 105:5582609. [PMID: 31589290 DOI: 10.1210/clinem/dgz069] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/03/2019] [Indexed: 12/21/2022]
Abstract
AIMS Recent trials provide conflicting results on the association between glucagon-like peptide 1 receptor agonists (GLP-1RA) and diabetic retinopathy (DR). The aim of the AngioSafe type 2 diabetes (T2D) study was to determine the role of GLP-1RA in angiogenesis using clinical and preclinical models. METHODS We performed two studies in humans. In study 1, we investigated the effect of GLP-1RA exposure from T2D diagnosis on the severity of DR, as diagnosed with retinal imaging (fundus photography). In study 2, a randomized 4-week trial, we assessed the effect of liraglutide on circulating hematopoietic progenitor cells (HPCs), and angio-miRNAs.We then studied the experimental effect of Exendin-4, on key steps of angiogenesis: in vitro on human endothelial cell proliferation, survival and three-dimensional vascular morphogenesis; and in vivo on ischemia-induced neovascularization of the retina in mice. RESULTS In the cohort of 3154 T2D patients, 10% displayed severe DR. In multivariate analysis, sex, disease duration, glycated hemoglobin (HbA1c), micro- and macroangiopathy, insulin therapy and hypertension remained strongly associated with severe DR, while no association was found with GLP-1RA exposure (o 1.139 [0.800-1.622], P = .47). We further showed no effect of liraglutide on HPCs, and angio-miRNAs. In vitro, we demonstrated that exendin-4 had no effect on proliferation and survival of human endothelial cells, no effect on total length and number of capillaries. Finally, in vivo, we showed that exendin-4 did not exert any negative effect on retinal neovascularization. CONCLUSIONS The AngioSafe T2D studies provide experimental and clinical data confirming no effect of GLP-1RA on angiogenesis and no association between GLP-1 exposure and severe DR.
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Affiliation(s)
- Bénédicte Gaborit
- Aix Marseille University, INSERM, INRA, C2VN, Marseille, France
- Endocrinology, Metabolic Diseases and Nutrition Department, Assistance Publique Hôpitaux de Marseille, France
| | - Jean-Baptiste Julla
- Department of Diabetes and Endocrinology, Assistance Publique - Hôpitaux de Paris, Lariboisière Hospital, University Paris-Diderot Paris-7, Paris, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, Paris, France
| | - Samaher Besbes
- Center for Interdisciplinary Research in Biology (CIRB), College de France - Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM), Paris Sciences et Lettres (PSL) Research University, Paris, France
| | - Matthieu Proust
- Center for Interdisciplinary Research in Biology (CIRB), College de France - Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM), Paris Sciences et Lettres (PSL) Research University, Paris, France
| | - Clara Vincentelli
- Aix Marseille University, INSERM, INRA, C2VN, Marseille, France
- Endocrinology, Metabolic Diseases and Nutrition Department, Assistance Publique Hôpitaux de Marseille, France
| | - Benjamin Alos
- Center for Interdisciplinary Research in Biology (CIRB), College de France - Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM), Paris Sciences et Lettres (PSL) Research University, Paris, France
| | - Patricia Ancel
- Aix Marseille University, INSERM, INRA, C2VN, Marseille, France
| | - Fawaz Alzaid
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, Paris, France
| | - Rodrigue Garcia
- Center for Interdisciplinary Research in Biology (CIRB), College de France - Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM), Paris Sciences et Lettres (PSL) Research University, Paris, France
| | - Philippe Mailly
- Center for Interdisciplinary Research in Biology (CIRB), College de France - Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM), Paris Sciences et Lettres (PSL) Research University, Paris, France
| | | | - Maud Righini
- Department of Ophtalmology, AP HM, Marseille, France
| | - Pierre Gascon
- Department of Ophtalmology, AP HM, Marseille, France
- Aix Marseille University, CNRS, INT, Inst Neurosci Timone, Marseille, France
| | - Frédéric Matonti
- Department of Ophtalmology, AP HM, Marseille, France
- Aix Marseille University, CNRS, INT, Inst Neurosci Timone, Marseille, France
| | - Marie Houssays
- Aix Marseille University, APHM, INSERM, CIC1409, Hôpital de la Conception, Marseille, France
| | - Louisa Goumidi
- Aix Marseille University, INSERM, INRA, C2VN, Marseille, France
| | - Lucile Vignaud
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France
| | | | - Ali Erginay
- Department of Ophthalmology, Lariboisière Hospital, AP HP, University Paris-Diderot Paris-7, Paris, France
| | - Bénédicte Dupas
- Department of Ophthalmology, Lariboisière Hospital, AP HP, University Paris-Diderot Paris-7, Paris, France
| | - Jennifer Marie-Louise
- Department of Ophthalmology, Lariboisière Hospital, AP HP, University Paris-Diderot Paris-7, Paris, France
| | - Marianne Autié
- Department of Ophthalmology, Lariboisière Hospital, AP HP, University Paris-Diderot Paris-7, Paris, France
| | - Tiphaine Vidal-Trecan
- Department of Diabetes and Endocrinology, Assistance Publique - Hôpitaux de Paris, Lariboisière Hospital, University Paris-Diderot Paris-7, Paris, France
| | - Jean-Pierre Riveline
- Department of Diabetes and Endocrinology, Assistance Publique - Hôpitaux de Paris, Lariboisière Hospital, University Paris-Diderot Paris-7, Paris, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, Paris, France
| | - Nicolas Venteclef
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, Paris, France
| | - Pascale Massin
- Department of Ophthalmology, Lariboisière Hospital, AP HP, University Paris-Diderot Paris-7, Paris, France
| | - Laurent Muller
- Center for Interdisciplinary Research in Biology (CIRB), College de France - Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM), Paris Sciences et Lettres (PSL) Research University, Paris, France
| | - Anne Dutour
- Aix Marseille University, INSERM, INRA, C2VN, Marseille, France
- Endocrinology, Metabolic Diseases and Nutrition Department, Assistance Publique Hôpitaux de Marseille, France
| | - Jean-François Gautier
- Department of Diabetes and Endocrinology, Assistance Publique - Hôpitaux de Paris, Lariboisière Hospital, University Paris-Diderot Paris-7, Paris, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, Paris, France
| | - Stéphane Germain
- Center for Interdisciplinary Research in Biology (CIRB), College de France - Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM), Paris Sciences et Lettres (PSL) Research University, Paris, France
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Quellec G, Lamard M, Conze PH, Massin P, Cochener B. Automatic detection of rare pathologies in fundus photographs using few-shot learning. Med Image Anal 2020; 61:101660. [PMID: 32028213 DOI: 10.1016/j.media.2020.101660] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 07/24/2019] [Revised: 11/19/2019] [Accepted: 01/23/2020] [Indexed: 12/24/2022]
Abstract
In the last decades, large datasets of fundus photographs have been collected in diabetic retinopathy (DR) screening networks. Through deep learning, these datasets were used to train automatic detectors for DR and a few other frequent pathologies, with the goal to automate screening. One challenge limits the adoption of such systems so far: automatic detectors ignore rare conditions that ophthalmologists currently detect, such as papilledema or anterior ischemic optic neuropathy. The reason is that standard deep learning requires too many examples of these conditions. However, this limitation can be addressed with few-shot learning, a machine learning paradigm where a classifier has to generalize to a new category not seen in training, given only a few examples of this category. This paper presents a new few-shot learning framework that extends convolutional neural networks (CNNs), trained for frequent conditions, with an unsupervised probabilistic model for rare condition detection. It is based on the observation that CNNs often perceive photographs containing the same anomalies as similar, even though these CNNs were trained to detect unrelated conditions. This observation was based on the t-SNE visualization tool, which we decided to incorporate in our probabilistic model. Experiments on a dataset of 164,660 screening examinations from the OPHDIAT screening network show that 37 conditions, out of 41, can be detected with an area under the ROC curve (AUC) greater than 0.8 (average AUC: 0.938). In particular, this framework significantly outperforms other frameworks for detecting rare conditions, including multitask learning, transfer learning and Siamese networks, another few-shot learning solution. We expect these richer predictions to trigger the adoption of automated eye pathology screening, which will revolutionize clinical practice in ophthalmology.
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Affiliation(s)
| | - Mathieu Lamard
- Univ Bretagne Occidentale, Brest, F-29200, France; Inserm, UMR 1101, Brest, F-29200, France
| | - Pierre-Henri Conze
- IMT Atlantique, Brest, F-29200, France; Inserm, UMR 1101, Brest, F-29200, France
| | - Pascale Massin
- Service d'Ophtalmologie, Hôpital Lariboisière, APHP, Paris, F-75475, France
| | - Béatrice Cochener
- Univ Bretagne Occidentale, Brest, F-29200, France; Inserm, UMR 1101, Brest, F-29200, France; Service d'Ophtalmologie, CHRU Brest, Brest, F-29200, France
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32
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Korobelnik JF, Daien V, Faure C, Tadayoni R, Giocanti-Auregan A, Dot C, Kodjikian L, Massin P. Real-world outcomes following 12 months of intravitreal aflibercept monotherapy in patients with diabetic macular edema in France: results from the APOLLON study. Graefes Arch Clin Exp Ophthalmol 2020; 258:521-528. [DOI: 10.1007/s00417-019-04592-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/20/2019] [Accepted: 12/24/2019] [Indexed: 11/29/2022] Open
Abstract
Abstract
Purpose
To report the effectiveness of intravitreal aflibercept (IVT-AFL) treatment for diabetic macular edema (DME) in French clinical practice.
Methods
APOLLON (NCT02924311) was a prospective, observational cohort study of patients with DME. Effectiveness was evaluated by change from baseline in best-corrected visual acuity (BCVA) at 12 months in treatment-naïve patients (i.e., had not received any anti-vascular endothelial growth factor [anti-VEGF] agent, laser, or steroid at IVT-AFL treatment start) and previously treated patients (i.e., previously treated with anti-VEGF agents other than IVT-AFL, laser, or steroids at IVT-AFL treatment start). Secondary endpoints included change in central retinal thickness (CRT) over 12 months, frequency of injections, and proportion of patients with safety events.
Results
Of the 147 patients followed for at least 12 months and included in the effectiveness analysis, 52.4% (n = 77) were treatment-naïve and 47.6% (n = 70) were previously treated. Mean (standard deviation [SD]) BCVA score at baseline was 62.7 (14.3) Early Treatment Diabetic Retinopathy Study (ETDRS) letters in treatment-naïve patients and 60.0 (13.7) ETDRS letters in previously treated patients. At month 12, mean (SD) change in BCVA was + 7.8 (12.3) letters in treatment-naïve patients and + 5.0 (11.3) letters in previously treated patients. Mean CRT decreased in both patient cohorts. The mean (SD) number of IVT-AFL injections at month 12 was 7.6 (2.5) for treatment-naïve patients and 7.6 (2.3) for previously treated patients. Of 388 patients included in the safety analysis, ocular treatment-emergent adverse events occurred in 54.1% (n = 210) of patients.
Conclusion
IVT-AFL treatment was associated with improvements in functional and anatomic outcomes in both treatment-naïve and previously treated patients with DME in France.
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Dupas B, Minvielle W, Bonnin S, Couturier A, Erginay A, Massin P, Gaudric A, Tadayoni R. Association Between Vessel Density and Visual Acuity in Patients With Diabetic Retinopathy and Poorly Controlled Type 1 Diabetes. JAMA Ophthalmol 2019; 136:721-728. [PMID: 29800967 DOI: 10.1001/jamaophthalmol.2018.1319] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Capillary dropout is a hallmark of diabetic retinopathy, but its role in visual loss remains unclear. Objective To examine how macular vessel density is correlated with visual acuity (VA) in patients younger than 40 years who have type 1 diabetes without macular edema but who have diabetic retinopathy requiring panretinal photocoagulation. Design, Settings, and Participants Retrospective cohort study of VA and optical coherence tomography angiography data collected from consecutive patients during a single visit to Lariboisière Hospital, a tertiary referral center in Paris, France. The cohort included 22 eyes of 22 patients with type 1 diabetes without macular edema but with bilateral rapidly progressive diabetic retinopathy that was treated with panretinal photocoagulation between August 15, 2015, and December 30, 2016. Eyes were classified into 2 groups by VA: normal (logMAR, 0; Snellen equivalent, 20/20) and decreased (logMAR, >0; Snellen equivalent, <20/20). The control group included 12 eyes from age-matched healthy participants with normal vision. Main Outcomes and Measures Visual acuity and mean vessel density in 4 retinal vascular plexuses: the superficial vascular plexus and the deep capillary complex, which comprises the intermediate capillary plexus and the deep capillary plexus. Results Of the 22 participants, 11 (50%) were men, mean (SD) age was 30 (6) years, and mean (SD) hemoglobin A1c level was 8.9% (1.6%). Of the 22 eyes with diabetic retinopathy, 13 (59%) had normal VA and 9 (41%) had decreased VA (mean [SD]: logMAR, 0.12 [0.04]; Snellen equivalent, 20/25). Mean [SE] vessel density was lower for eyes with diabetic retinopathy and normal VA compared with the control group in the superficial vascular plexus (44.1% [0.9%] vs 49.1% [0.9%]; difference, -5.0% [1.3%]; 95% CI, -7.5% to -2.4%; P < .001), in the deep capillary complex (44.3% [1.2%] vs 50.6% [1.3%]; difference, -6.3% [1.8%]; 95% CI, -9.9% to -2.7%; P = .001), in the intermediate capillary plexus (43.8% [1.2%] vs 49.3% [1.2%]; difference, -5.5% [1.7%]; 95% CI, -9.0% to -2.0%; P = .003), and in the deep capillary plexus (24.5% [1.0%] vs 30.5% [1.0%]; difference, -6.1% [1.4%]; 95% CI, -8.9% to -3.2%; P < .001). Mean vessel density was lower in eyes with diabetic retinopathy and decreased VA compared with eyes with diabetic retinopathy and normal VA; the mean (SE) loss was more pronounced in the deep capillary complex (34.6% [1.5%] vs 44.3% [1.2%]; difference, -9.6% [1.9%]; 95% CI, -13.6% to -5.7%; P < .001), especially in the deep capillary plexus (15.2% [1.2%] vs 24.5% [1.0%]; difference, -9.3% [1.5%]; 95% CI, -12.4% to -6.1%; P < .001), than in the superficial vascular plexus (39.6% [1.1%] vs 44.1% [0.9%]; difference, -4.5% [1.4%]; 95% CI, -7.3% to -1.7%; P = .002). Conclusions and Relevance These data suggest that in patients with type 1 diabetes without macular edema but with severe nonproliferative or proliferative diabetic retinopathy, decreased VA may be associated with the degree of capillary loss in the deep capillary complex.
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Affiliation(s)
- Bénédicte Dupas
- Department of Ophthalmology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne Paris Cité, Paris, France
| | - Wilfried Minvielle
- Department of Ophthalmology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne Paris Cité, Paris, France
| | - Sophie Bonnin
- Department of Ophthalmology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne Paris Cité, Paris, France
| | - Aude Couturier
- Department of Ophthalmology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne Paris Cité, Paris, France
| | - Ali Erginay
- Department of Ophthalmology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne Paris Cité, Paris, France
| | - Pascale Massin
- Department of Ophthalmology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne Paris Cité, Paris, France
| | - Alain Gaudric
- Department of Ophthalmology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne Paris Cité, Paris, France
| | - Ramin Tadayoni
- Department of Ophthalmology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University Sorbonne Paris Cité, Paris, France
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Gabrielle P, Massin P, Kodjikian L, Erginay A, Pallot C, Jonval L, Soudry A, Couturier A, Vardanian‐Vartin C, Bron AM, Creuzot‐Garcher C. Central retinal thickness following panretinal photocoagulation using a multispot semi-automated pattern-scanning laser to treat ischaemic diabetic retinopathy: Treatment in one session compared with four monthly sessions. Acta Ophthalmol 2019; 97:e680-e687. [PMID: 30561087 DOI: 10.1111/aos.14002] [Citation(s) in RCA: 2] [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: 06/30/2018] [Accepted: 11/21/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE To compare central retinal thickness (CRT) after panretinal photocoagulation (PRP) with a multispot semi-automated PAttern-SCAnning Laser (PASCAL) in one session (SS-PRP) versus four monthly sessions (MS-PRP) in diabetic retinopathy. METHODS Multicentre, prospective, randomized, single-blinded, controlled trial evaluating the noninferiority of SS-PRP versus MS-PRP for CRT measured with macular spectral-domain optical coherence tomography (SD-OCT), with a 9-month follow-up in patients presenting severe nonproliferative diabetic retinopathy (DR) or mild proliferative DR without macular oedema (ME) at baseline. RESULTS Ninety-seven eyes of 97 participants with a mean age of 57.0 ± 14.2 years were included. The mean change of CRT from baseline to 9 months was not statistically different in SS-PRP or in MS-PRP: +16.9 ± 28.3 μm versus +24.7 ± 31.8 μm, respectively (p = 0.224). The variation in mean best-corrected visual acuity (BCVA) from baseline to 9 months was similar in both groups: -1.1 ± 6.5 letters versus -0.6 ± 6.2 letters (p = 0.684). The number of patients with stabilization of DR was not statistically different between the two groups. No severe complication was recorded in either group. CONCLUSION This study showed the noninferiority of PRP performed in one session versus four monthly sessions with a PASCAL concerning central retinal thickness for treating mild proliferative or severe nonproliferative DR without ME at baseline.
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Affiliation(s)
- Pierre‐Henry Gabrielle
- Department of Ophthalmology University Hospital Dijon France
- Eye and Nutrition Research Group Centre des Sciences du Goût et de l'Alimentation UMR1324 INRA 6265 CNRS University of Bourgogne Franche‐Comté Dijon France
| | - Pascale Massin
- Department of Ophthalmology Hôpital Lariboisière AP‐HP Université Paris 7 – Sorbonne Paris Cité Paris France
| | - Laurent Kodjikian
- Department of Ophthalmology Croix‐Rousse teaching Hospital Hospices Civil de Lyon Lyon France
| | - Ali Erginay
- Department of Ophthalmology Hôpital Lariboisière AP‐HP Université Paris 7 – Sorbonne Paris Cité Paris France
| | - Charlotte Pallot
- Department of Ophthalmology University Hospital Dijon France
- Eye and Nutrition Research Group Centre des Sciences du Goût et de l'Alimentation UMR1324 INRA 6265 CNRS University of Bourgogne Franche‐Comté Dijon France
| | - Lysiane Jonval
- Department of Clinical Research and Epidemiology University Hospital Dijon France
| | - Agnès Soudry
- Department of Clinical Research and Epidemiology University Hospital Dijon France
| | - Aude Couturier
- Department of Ophthalmology Hôpital Lariboisière AP‐HP Université Paris 7 – Sorbonne Paris Cité Paris France
| | | | - Alain M. Bron
- Department of Ophthalmology University Hospital Dijon France
- Eye and Nutrition Research Group Centre des Sciences du Goût et de l'Alimentation UMR1324 INRA 6265 CNRS University of Bourgogne Franche‐Comté Dijon France
| | - Catherine Creuzot‐Garcher
- Department of Ophthalmology University Hospital Dijon France
- Eye and Nutrition Research Group Centre des Sciences du Goût et de l'Alimentation UMR1324 INRA 6265 CNRS University of Bourgogne Franche‐Comté Dijon France
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Massin P, Creuzot-Garcher C, Kodjikian L, Girmens JF, Delcourt C, Fajnkuchen F, Glacet-Bernard A, Guillausseau PJ, Ponthieux A, Blin P, Grelaud A. Real-World Outcomes with Ranibizumab 0.5 mg in Patients with Visual Impairment due to Diabetic Macular Edema: 12-Month Results from the 36-Month BOREAL-DME Study. Ophthalmic Res 2019; 62:101-110. [PMID: 30928985 DOI: 10.1159/000497406] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/01/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To report the real-world effectiveness and safety of ranibizumab 0.5 mg in patients with visual impairment due to diabetic macular edema (DME). METHODS This is a French, 36-month, multicenter, observational cohort study. Between December 2013 and April 2015, ophthalmologists enrolled diabetic patients aged ≥18 years with DME-related visual impairment and for whom ranibizumab 0.5 mg was initiated. Here, we present the 12-month results from this cohort. The primary endpoint was the mean change in best-corrected visual acuity (BCVA); sample size calculations were based on RESTORE trial data (BCVA mean change = 6.8 letters, preci sion = 0.7 letters). Secondary endpoints included the change in central subfield thickness (CSFT), number of visits, number of injections received, and frequency of ocular and nonocular adverse events and serious adverse events. RESULTS Between December 2013 and April 2015, a total of 290 patients with DME were enrolled by 84 ophthalmologists; 12-month data are available for 242 patients (due to low recruitment rates, precision was recalculated for 242 evaluable patients: the precision was then of 1.0 letters). Mean age (± standard deviation) was 66.1 ± 11.0 years and 56.6% were male. The mean baseline BCVA and CSFT were 59.2 letters (95% confidence interval [CI] 57.3, 61.0) and 457 μm (95% CI: 438, 476), respectively. At month 12, the mean gain in BCVA from baseline was 7.4 letters (95% CI: 5.4, 9.4), with 36.8% of patients with BCVA > 70 letters versus 13.2% at baseline. Mean change in CSFT was -125 μm (95% CI: -146, -103). The mean number of ranibizumab injections was 5.1 ± 2.3 over an average of 10.4 ± 3.0 visits. No new safety findings were identified. CONCLUSIONS The BOREAL study confirms the effectiveness and safety of ranibizumab for the treatment of DME-related visual impairment in routine clinical practice with fewer injections than reported in clinical trials.
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Affiliation(s)
| | | | - Laurent Kodjikian
- Ophthalmology, Hopital de la Croix Rousse, Lyon University, UMR CNRS MATEIS 5510, Lyon, France
| | | | - Cecile Delcourt
- Inserm U1219 - Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | | | - Agnès Glacet-Bernard
- Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Paris-Est Créteil University, Créteil, France
| | | | | | - Patrick Blin
- Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, Bordeaux, France
| | - Angela Grelaud
- Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, Bordeaux, France
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Simó R, Hernández C, Porta M, Bandello F, Grauslund J, Harding SP, Aldington SJ, Egan C, Frydkjaer-Olsen U, García-Arumí J, Gibson J, Lang GE, Lattanzio R, Massin P, Midena E, Ponsati B, Ribeiro L, Scanlon P, Lobo C, Costa MÂ, Cunha-Vaz J. Effects of Topically Administered Neuroprotective Drugs in Early Stages of Diabetic Retinopathy: Results of the EUROCONDOR Clinical Trial. Diabetes 2019; 68:457-463. [PMID: 30389750 DOI: 10.2337/db18-0682] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/21/2018] [Indexed: 12/25/2022]
Abstract
The primary objective of this study was to assess whether the topical administration of two neuroprotective drugs (brimonidine and somatostatin) could prevent or arrest retinal neurodysfunction in patients with type 2 diabetes. For this purpose, adults aged between 45 and 75 years with a diabetes duration ≥5 years and an Early Treatment of Diabetic Retinopathy Study (ETDRS) level of ≤35 were randomly assigned to one of three arms: placebo, somatostatin, or brimonidine. The primary outcome was the change in implicit time (IT) assessed by multifocal electroretinography between baseline and at the end of follow-up (96 weeks). There were 449 eligible patients allocated to brimonidine (n = 152), somatostatin (n = 145), or placebo (n = 152). When the primary end point was evaluated in the whole population, we did not find any neuroprotective effect of brimonidine or somatostatin. However, in the subset of patients (34.7%) with preexisting retinal neurodysfunction, IT worsened in the placebo group (P < 0.001) but remained unchanged in the brimonidine and somatostatin groups. In conclusion, the topical administration of the selected neuroprotective agents appears useful in preventing the worsening of preexisting retinal neurodysfunction. This finding points to screening retinal neurodysfunction as a critical issue to identify a subset of patients in whom neuroprotective treatment might be of benefit.
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Affiliation(s)
- Rafael Simó
- Diabetes and Metabolism Research Unit and CIBERDEM, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Cristina Hernández
- Diabetes and Metabolism Research Unit and CIBERDEM, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Massimo Porta
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milano, Italy
| | - Jakob Grauslund
- Research Unit of Ophthalmology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Simon P Harding
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, U.K
| | - Stephen J Aldington
- Gloucestershire Hospitals National Health Service Foundation Trust, Cheltenham, U.K
| | - Catherine Egan
- Moorfields Eye Hospital National Health Service Foundation Trust, Institute of Ophthalmology/University College London, London, U.K
| | - Ulrik Frydkjaer-Olsen
- Research Unit of Ophthalmology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - José García-Arumí
- Department of Ophthalmology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jonathan Gibson
- Department of Vision Sciences, Aston University, Birmingham, U.K
| | - Gabriele E Lang
- Department of Ophthalmology, University of Ulm, Ulm, Germany
| | - Rosangela Lattanzio
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milano, Italy
| | - Pascale Massin
- Department of Ophthalmology, Lariboisière Hospital, Paris, France
| | - Edoardo Midena
- Department of Ophthalmology, University of Padova, Padova, Italy
| | | | - Luísa Ribeiro
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal, and Faculty of Medicine, University of Coimbra, Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Peter Scanlon
- Gloucestershire Hospitals National Health Service Foundation Trust, Cheltenham, U.K
| | - Conceição Lobo
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal, and Faculty of Medicine, University of Coimbra, Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Miguel Ângelo Costa
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal, and Faculty of Medicine, University of Coimbra, Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
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Figueira J, Fletcher E, Massin P, Silva R, Bandello F, Midena E, Varano M, Sivaprasad S, Eleftheriadis H, Menon G, Amaro M, Ayello Scheer S, Creuzot-Garcher C, Nascimento J, Alves D, Nunes S, Lobo C, Cunha-Vaz J. Ranibizumab Plus Panretinal Photocoagulation versus Panretinal Photocoagulation Alone for High-Risk Proliferative Diabetic Retinopathy (PROTEUS Study). Ophthalmology 2018; 125:691-700. [PMID: 29395119 DOI: 10.1016/j.ophtha.2017.12.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/10/2017] [Accepted: 12/04/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Comparison of the efficacy of ranibizumab (RBZ) 0.5 mg intravitreal injections plus panretinal photocoagulation (PRP) versus PRP alone in the regression of the neovascularization (NV) area in subjects with high-risk proliferative diabetic retinopathy (HR-PDR) over a 12-month period. DESIGN Prospective, randomized, multicenter, open-label, phase II/III study. PARTICIPANTS Eighty-seven participants (aged ≥18 years) with type 1/2 diabetes and HR-PDR (mean age, 55.2 years; 37% were female). METHODS Participants were randomized (1:1) to receive RBZ+PRP (n = 41) or PRP monotherapy (n = 46). The RBZ+PRP group received 3 monthly RBZ injections along with standard PRP. The PRP monotherapy group received standard PRP between day 1 and month 2; thereafter, re-treatments in both groups were at the investigators' discretion. MAIN OUTCOME MEASURES The primary outcome was regression of NV total, on the disc (NVD) plus elsewhere (NVE), defined as any decrease in the area of NV from the baseline to month 12. Secondary outcomes included best-corrected visual acuity (BCVA) changes from baseline to month 12, time to complete NV regression, recurrence of NV, macular retinal thickness changes from baseline to month 12, need for treatment for diabetic macular edema, need for vitrectomy because of occurrence of vitreous hemorrhage, tractional retinal detachment or other complications of DR, and adverse events (AEs) related to treatments. RESULTS Seventy-seven participants (88.5%) completed the study. Overall baseline demographics were similar for both groups, except for age. At month 12, 92.7% of participants in the RBZ+PRP group presented NV total reduction versus 70.5% of the PRP monotherapy participants (P = 0.009). The number of participants with NVD and NVE reductions was higher with RBZ+PRP (93.3% and 91.4%, respectively) versus PRP (68.8% and 73.7%, respectively), significant only for NVE (P = 0.048). Complete NV total regression was observed in 43.9% in the RBZ+PRP group versus 25.0% in the PRP monotherapy group (P = 0.066). At month 12, the mean BCVA was 75.2 letters (20/32) in the RBZ+PRP group versus 69.2 letters (20/40) in the PRP monotherapy group (P = 0.104). In the RBZ+PRP group, the mean number of PRP treatments over month 12 was 3.5±1.3, whereas in the PRP monotherapy group, it was 4.6±1.5 (P = 0.001). No deaths or unexpected AEs were reported. CONCLUSIONS Treatment with RBZ+PRP was more effective than PRP monotherapy for NV regression in HR-PDR participants over 12 months.
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Affiliation(s)
- João Figueira
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.
| | - Emily Fletcher
- Department of Ophthalmology, Gloucestershire Hospitals, Gloucestershire, United Kingdom
| | - Pascale Massin
- Department of Ophthalmology, Lariboisière Hospital, Paris, France
| | - Rufino Silva
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; Coimbra Medical Space, Coimbra, Portugal
| | - Francesco Bandello
- Department of Ophthalmology University Vita-Salute, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Edoardo Midena
- Centre for Clinical Trials, Department of Ophthalmology University of Padova, Padova, Italy
| | | | - Sobha Sivaprasad
- Laser Retinal Research Unit, King's Health Partners, London, United Kingdom
| | | | - Geeta Menon
- Ophthalmology Clinical Trials Unit Frimley, Frimley, United Kingdom
| | - Miguel Amaro
- Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Sarah Ayello Scheer
- Centre d'Investigation Clinique, Centre National d'Ophthalmologie des Quinze-Vingts, Paris, France
| | | | - João Nascimento
- Instituto de Retina e Diabetes Oculares de Lisboa, Lisbon, Portugal
| | - Dalila Alves
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | - Sandrina Nunes
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | - Conceição Lobo
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - José Cunha-Vaz
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
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Wautier MP, Boulanger E, Guillausseau PJ, Massin P, Wautier JL. AGEs, macrophage colony stimulating factor and vascular adhesion molecule blood levels are increased in patients with diabetic microangiopathy. Thromb Haemost 2017; 91:879-85. [PMID: 15116247 DOI: 10.1160/th03-07-0486] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Summary
In vitro experiments and animal models indicate that advanced glycation end products (AGEs) may play a crucial role in the vascular dysfunctions observed in patients with diabetes mellitus. These results prompted us to study subrogate markers of inflammation or vascular dysfunction in type II diabetic patients. Monocyte count and activation are dependent upon macrophage colony stimulating factors (M-CSF). Soluble vascular cell adhesion molecule (sVCAM-1) blood levels have been proposed as a marker for endothelium activation. To explore a possible relationship between these factors in diabetic patients, we measured a chemically defined AGE, N(carboxymethyl)lysineprotein (CML-protein) in a group of normal subjects (n = 55) and of diabetic patients (n = 40) using ELISA. Simultaneously, we determined M-CSF and sVCAM-1 blood levels. We found that CML-protein blood levels were significantly higher in patients with diabetes compared to non-diabetic subjects (40.2 ± 4.7 and 7.9 ± 0.7 pmol/mg protein respectively, p < 0.0001). M-CSF was increased while sVCAM-1 blood levels were normal in the group of diabetics. M-CSF blood level was correlated to CML-protein blood level (p < 0.05). In addition CML-protein, M-CSF and sVCAM-1 were increased in patients with microangiopathy. These results suggest that AGE may contribute to vascular dysfunction including microangiopathy.
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Affiliation(s)
- Marie-Paule Wautier
- Institut National de la Transfusion Sanguine, Département de Biologie Cellulaire, Université Paris, France.
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Feldman-Billard S, Larger É, Massin P. Early worsening of diabetic retinopathy after rapid improvement of blood glucose control in patients with diabetes. Diabetes Metab 2017; 44:4-14. [PMID: 29217386 DOI: 10.1016/j.diabet.2017.10.014] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 10/27/2017] [Accepted: 10/29/2017] [Indexed: 12/18/2022]
Abstract
AIM To review the frequency, importance of and risk factors for "early worsening of diabetic retinopathy" (EWDR) after rapid improvement of blood glucose in patients with diabetes. METHODS This was a systematic review of key references (PubMed 1980-2016) and the current international recommendations for the above-mentioned topics. RESULTS EWDR has been described during intensive treatment (IT) in patients with uncontrolled type 1 or 2 diabetes, and after pancreas transplantation or bariatric surgery. EWDR arises in 10-20% of patients within 3-6 months after abrupt improvement of glucose control, and in nearly two times that proportion in patients with advanced baseline diabetic retinopathy (DR). While EWDR is often transient and predominantly driven by the development of cotton-wool spots and intraretinal microvascular abnormalities in patients with no or minimal DR, it can lead to irreversible retinal damage in patients with advanced DR before IT. Its identified risk factors include higher baseline levels and larger magnitudes of reduction of HbA1c, longer diabetes durations and previous severity of DR. CONCLUSION Intensive diabetes treatment inducing a rapid fall in glucose should prompt vigilance and caution, particularly in patients with long-term and uncontrolled diabetes and DR prior to IT. Careful retinal examination should be performed in all patients before initiating IT; however, in patients with severe non-proliferative or proliferative DR, panretinal photocoagulation therapy should be performed promptly. During the year following IT, quarterly eye monitoring is required in patients at high risk of EWDR (long-term uncontrolled diabetes, previous advanced DR), whereas follow-up every 6 months can be applied in patients with short-term diabetes and no/minimal DR before IT. To date, there is no evidence that controlling the speed or magnitude of HbA1c decreases will reduce the risk of EWDR in patients with diabetes.
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Affiliation(s)
- S Feldman-Billard
- Service de médecine interne, CHNO des Quinze-Vingts, 28, rue de Charenton, 75571 Paris cedex 12, France.
| | - É Larger
- Département hospitalo-universitaire, service de diabétologie, hôpital Cochin, 75014 Paris, France; Inserm U1016, Institut Cochin, université de Paris René Descartes, 75014 P aris, France
| | - P Massin
- Centre d'ophtalmologie Breteuil, centre Broca, hôpital Lariboisière, Paris, France
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Santos AR, Ribeiro L, Bandello F, Lattanzio R, Egan C, Frydkjaer-Olsen U, García-Arumí J, Gibson J, Grauslund J, Harding SP, Lang GE, Massin P, Midena E, Scanlon P, Aldington SJ, Simão S, Schwartz C, Ponsati B, Porta M, Costa MÂ, Hernández C, Cunha-Vaz J, Simó R. Functional and Structural Findings of Neurodegeneration in Early Stages of Diabetic Retinopathy: Cross-sectional Analyses of Baseline Data of the EUROCONDOR Project. Diabetes 2017; 66:2503-2510. [PMID: 28663190 DOI: 10.2337/db16-1453] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 06/19/2017] [Indexed: 11/13/2022]
Abstract
This cross-sectional study evaluated the relationship between 1) functional and structural measurements of neurodegeneration in the initial stages of diabetic retinopathy (DR) and 2) the presence of neurodegeneration and early microvascular impairment. We analyzed baseline data of 449 patients with type 2 diabetes enrolled in the European Consortium for the Early Treatment of Diabetic Retinopathy (EUROCONDOR) study (NCT01726075). Functional studies by multifocal electroretinography (mfERG) evaluated neurodysfunction, and structural measurements using spectral domain optical coherence tomography (SD-OCT) evaluated neurodegeneration. The mfERG P1 amplitude was more sensitive than the P1 implicit time and was lower in patients with Early Treatment of Diabetic Retinopathy Study (ETDRS) level 20-35 than in patients with ETDRS level <20 (P = 0.005). In 58% of patients, mfERG abnormalities were present in the absence of visible retinopathy. Correspondence between SD-OCT thinning and mfERG abnormalities was shown in 67% of the eyes with ETDRS <20 and in 83% of the eyes with ETDRS level 20-35. Notably, 32% of patients with ETDRS 20-35 presented no abnormalities in mfERG or SD-OCT. We conclude that there is a link between mfERG and SD-OCT measurements that increases with the presence of microvascular impairment. However, a significant proportion of patients in our particular study population (ETDRS ≤35) had normal ganglion cell-inner plexiform layer thickness and normal mfERG findings. We raise the hypothesis that neurodegeneration may play a role in the pathogenesis of DR in many but not in all patients with type 2 diabetes.
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Affiliation(s)
- Ana Rita Santos
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
- Superior School of Health, Polytechnic Institute of Porto, Porto, Portugal
| | - Luísa Ribeiro
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Rosangela Lattanzio
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Catherine Egan
- Moorfields Eye Hospital National Health Service Foundation Trust, Institute of Ophthalmology/University College London, London, U.K
| | - Ulrik Frydkjaer-Olsen
- Research Unit of Ophthalmology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - José García-Arumí
- Department of Ophthalmology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jonathan Gibson
- Department of Vision Sciences, Aston University, Birmingham, U.K
| | - Jakob Grauslund
- Research Unit of Ophthalmology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Simon P Harding
- Department of Eye & Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, U.K
| | - Gabriele E Lang
- Department of Ophthalmology, University of Ulm, Ulm, Germany
| | - Pascale Massin
- Department of Ophthalmology, Lariboisière Hospital, Paris, France
| | - Edoardo Midena
- Department of Ophthalmology, University of Padova, Padova, Italy
| | - Peter Scanlon
- Gloucestershire Hospitals National Health Service Foundation Trust, Cheltenham, U.K
| | - Stephen J Aldington
- Gloucestershire Hospitals National Health Service Foundation Trust, Cheltenham, U.K
| | - Sílvia Simão
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | - Christian Schwartz
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | | | - Massimo Porta
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Miguel Ângelo Costa
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | - Cristina Hernández
- Diabetes and Metabolism Research Unit and CIBERDEM, Vall d'Hebron Research Institute, Barcelona, Spain
| | - José Cunha-Vaz
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | - Rafael Simó
- Diabetes and Metabolism Research Unit and CIBERDEM, Vall d'Hebron Research Institute, Barcelona, Spain
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Blin P, Delcourt C, Massin P, Guillausseau PJ, Creuzot-Garcher C, Kodjikian L, Lassalle R, Chartier A, Bernard MA, Hamoud F, Maizi H, Finzi L, Droz-Perroteau C, Grolleau A, Grelaud A, Moore N. Efficacité en vie réelle du traitement par injection intravitréenne de ranibizumab pour une baisse de l’acuité visuelle due à un œdème maculaire diabétique : la cohorte BOREAL. Rev Epidemiol Sante Publique 2017. [DOI: 10.1016/j.respe.2017.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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42
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Briand FX, Schmitz A, Ogor K, Le Prioux A, Guillou-Cloarec C, Guillemoto C, Allée C, Le Bras MO, Hirchaud E, Quenault H, Touzain F, Cherbonnel-Pansart M, Lemaitre E, Courtillon C, Gares H, Daniel P, Fediaevsky A, Massin P, Blanchard Y, Eterradossi N, van der Werf S, Jestin V, Niqueux E. Emerging highly pathogenic H5 avian influenza viruses in France during winter 2015/16: phylogenetic analyses and markers for zoonotic potential. ACTA ACUST UNITED AC 2017; 22:30473. [PMID: 28277218 PMCID: PMC5356430 DOI: 10.2807/1560-7917.es.2017.22.9.30473] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 08/10/2016] [Indexed: 11/20/2022]
Abstract
Several new highly pathogenic (HP) H5 avian influenza virus (AIV) have been detected in poultry farms from south-western France since November 2015, among which an HP H5N1. The zoonotic potential and origin of these AIVs immediately became matters of concern. One virus of each subtype H5N1 (150169a), H5N2 (150233) and H5N9 (150236) was characterised. All proved highly pathogenic for poultry as demonstrated molecularly by the presence of a polybasic cleavage site in their HA protein – with a sequence (HQRRKR/GLF) previously unknown among avian H5 HPAI viruses – or experimentally by the in vivo demonstration of an intravenous pathogenicity index of 2.9 for the H5N1 HP isolate. Phylogenetic analyses based on the full genomes obtained by NGS confirmed that the eight viral segments of the three isolates were all part of avian Eurasian phylogenetic lineage but differed from the Gs/Gd/1/96-like lineage. The study of the genetic characteristics at specific amino acid positions relevant for modulating the adaptation to and the virulence for mammals showed that presently, these viruses possess most molecular features characteristic of AIV and lack some major characteristics required for efficient respiratory transmission to or between humans. The three isolates are therefore predicted to have no significant pandemic potential.
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Affiliation(s)
- François-Xavier Briand
- Anses, Unité VIPAC - LNR influenza aviaire, Ploufragan, France.,Université Bretagne-Loire, Rennes, France
| | - Audrey Schmitz
- Anses, Unité VIPAC - LNR influenza aviaire, Ploufragan, France.,Université Bretagne-Loire, Rennes, France
| | - Katell Ogor
- Anses, Unité VIPAC - LNR influenza aviaire, Ploufragan, France.,Université Bretagne-Loire, Rennes, France
| | - Aurélie Le Prioux
- Anses, Unité VIPAC - LNR influenza aviaire, Ploufragan, France.,Université Bretagne-Loire, Rennes, France
| | - Cécile Guillou-Cloarec
- Anses, Unité VIPAC - LNR influenza aviaire, Ploufragan, France.,Université Bretagne-Loire, Rennes, France
| | - Carole Guillemoto
- Anses, Unité VIPAC - LNR influenza aviaire, Ploufragan, France.,Université Bretagne-Loire, Rennes, France
| | - Chantal Allée
- Anses, Unité VIPAC - LNR influenza aviaire, Ploufragan, France.,Université Bretagne-Loire, Rennes, France
| | - Marie-Odile Le Bras
- Anses, Unité VIPAC - LNR influenza aviaire, Ploufragan, France.,Université Bretagne-Loire, Rennes, France
| | - Edouard Hirchaud
- Université Bretagne-Loire, Rennes, France.,Anses, Unité Génétique Virale et Biosécurité, Ploufragan, France
| | - Hélène Quenault
- Université Bretagne-Loire, Rennes, France.,Anses, Unité Génétique Virale et Biosécurité, Ploufragan, France
| | - Fabrice Touzain
- Université Bretagne-Loire, Rennes, France.,Anses, Unité Génétique Virale et Biosécurité, Ploufragan, France
| | - Martine Cherbonnel-Pansart
- Anses, Unité VIPAC - LNR influenza aviaire, Ploufragan, France.,Université Bretagne-Loire, Rennes, France
| | - Evelyne Lemaitre
- Anses, Unité VIPAC - LNR influenza aviaire, Ploufragan, France.,Université Bretagne-Loire, Rennes, France
| | - Céline Courtillon
- Anses, Unité VIPAC - LNR influenza aviaire, Ploufragan, France.,Université Bretagne-Loire, Rennes, France
| | - Hélène Gares
- Laboratoire Départemental d'Analyses et de Recherche, Coulounieix Chamiers, France
| | - Patrick Daniel
- Laboratoire des Pyrénées et des Landes, Mont-de-Marsan, France
| | | | - Pascale Massin
- Anses, Unité VIPAC - LNR influenza aviaire, Ploufragan, France.,Université Bretagne-Loire, Rennes, France
| | - Yannick Blanchard
- Université Bretagne-Loire, Rennes, France.,Anses, Unité Génétique Virale et Biosécurité, Ploufragan, France
| | - Nicolas Eterradossi
- Anses, Unité VIPAC - LNR influenza aviaire, Ploufragan, France.,Université Bretagne-Loire, Rennes, France
| | - Sylvie van der Werf
- Institut Pasteur, Unité Génétique Moléculaire des Virus à ARN - CNR grippe, Paris, France.,Anses - Groupe d'Experts Spécialisé Santé Animale et Bien-être Animal, Maisons-Alfort, France
| | - Véronique Jestin
- Anses - Groupe d'Experts Spécialisé Santé Animale et Bien-être Animal, Maisons-Alfort, France
| | - Eric Niqueux
- Anses, Unité VIPAC - LNR influenza aviaire, Ploufragan, France.,Université Bretagne-Loire, Rennes, France
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Bandello F, Battaglia Parodi M, Lanzetta P, Loewenstein A, Massin P, Menchini F, Veritti D. Diabetic Macular Edema. Dev Ophthalmol 2017; 58:102-138. [PMID: 28351052 DOI: 10.1159/000455277] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Diabetic macular edema (DME), defined as a retinal thickening involving or approaching the center of the macula, represents the most common cause of vision loss in patients affected by diabetes mellitus. In the last few years, many diagnostic tools have proven to be useful in the detection and the monitoring of the features characterizing DME. On the other hand, several therapeutic approaches can now be proposed on the basis of the DME-specific characteristics. The aim of the present chapter is to thoroughly delineate the clinical and morphofunctional characteristics of DME and its current treatment perspectives. The pathogenesis and the course of DME require a complex approach with multidisciplinary intervention both at the systemic and local levels.
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Reina N, Bonnevialle P, Rubens Duval B, Adam P, Loubignac F, Favier T, Massin P. Internal fixation of intra-capsular proximal femoral fractures in patients older than 80 years: Still relevant? Multivariate analysis of a prospective multicentre cohort. Orthop Traumatol Surg Res 2017; 103:3-7. [PMID: 27919767 DOI: 10.1016/j.otsr.2016.10.013] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/21/2016] [Accepted: 10/06/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Arthroplasty is now widely used to treat intra-capsular proximal femoral fractures (PFFs) in older patients, even when there is little or no displacement. However, whether arthroplasty is associated with lower mortality and complication rates in non-displaced or mildly displaced PFFs is unknown. The objectives of this prospective study were: (1) to evaluate early mortality rates with the two treatment methods, (2) to identify risk factors for complications, (3) and to identify predictors of functional decline. HYPOTHESIS Arthroplasty and internal fixation produce similar outcomes in non-displaced fractures of patients older than 80 years with PFFs. MATERIAL AND METHODS This multicentre prospective study included consecutive patients older than 80 years who were managed for intra-capsular PFFs at eight centres in 2014. Biometric data and geriatric assessment scores (Parker Mobility Score, Katz Index of Independence, and Mini-Nutritional Assessment [MNA] score) were collected before and 6 months after surgery. Independent risk factors were sought by multivariate analysis. We included 418 females and 124 males with a mean age of 87±4years. The distribution of Garden stages was stage I, n=56; stage II, n=33; stage III, n=130; and stage IV, n=323. Arthroplasty was performed in 494 patients and internal fixation in 48 patients with non-displaced intra-capsular PFFs. RESULTS Mortality after 6 months was 16.4% overall, with no significant difference between the two groups. By multivariate analysis, two factors were significantly associated with higher mortality, namely, male gender (odds ratio [OR], 3.24; 95% confidence interval [95% CI], 2.0-5.84; P<0.0001) and high ASA score (OR, 1.56; 95% CI, 1.07-2.26; P=0.019). Two factors were independently associated with lower mortality, with 75% predictive value, namely, high haematocrit (OR, 0.8; 95% CI, 0.7-0.9; P=0.001) and better Parker score (OR, 0.5; 95% CI, 0.3-0.8; P=0.01). The cut-off values associated with a significant risk increase were 2 for the Parker score (OR, 1.8; 95% CI, 1.1-2.3; P=0.001) and 37% for the haematocrit (OR, 3.3; 95% CI, 1.9-5.5; P=0.02). Complications occurred in 5.5% of patients. Surgical site infections were seen in 1.4% of patients, all of whom had had arthroplasty. Blood loss was significantly greater with arthroplasty (311±197mL versus 201±165mL, P<0.0002). Dependency worsened in 39% of patients, and 31% of patients lost self-sufficiency. A higher preoperative Parker score was associated with a lower risk of high postoperative dependency (OR, 0.86; 95% CI, 0.76-0.97; P=0.014). DISCUSSION Neither treatment method was associated with decreased mortality or better function after intra-capsular PFFs in patients older than 80 years. Early mortality rates were consistent with previous reports. Among the risk factors identified in this study, age, preoperative self-sufficiency, and gender are not amenable to modification, in contrast to haematocrit and blood loss. CONCLUSION Internal fixation remains warranted in patients older than 80 years with non-displaced intra-capsular PFFs. LEVEL OF EVIDENCE III, prospective case-control study.
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Affiliation(s)
- N Reina
- Hôpital Pierre-Paul-Riquet, CHU de Toulouse, rue Jean-Dausset, 31000 Toulouse, France
| | - P Bonnevialle
- Hôpital Pierre-Paul-Riquet, CHU de Toulouse, rue Jean-Dausset, 31000 Toulouse, France
| | - B Rubens Duval
- Hôpital Sud, CHU de Grenoble, avenue de Kimberley, 38130 Échirolles, France
| | - P Adam
- CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | - F Loubignac
- Centre hospitalier intercommunal de Toulon, 54, avenue Henri-Sainte-Claire-Deville, La Seyne-sur-Mer, 83100 Toulon, France
| | - T Favier
- Clinique Toutes Aures, 393, avenue des Savels, 04100 Manosque, France
| | - P Massin
- Hôpitaux universitaires Paris Nord Val-de-Seine, 100, boulevard du Général-Leclerc, 92110 Clichy, France; EA 7334 REMES (Recherche Clinique Coordonnée Ville-Hôpital, Méthodologie et Société) Université Paris-Diderot, Sorbonne Paris Cité, 75010 Paris, France.
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Chiquet C, Aptel F, Creuzot-Garcher C, Berrod JP, Kodjikian L, Massin P, Deloche C, Perino J, Kirwan BA, de Brouwer S, Combette JM, Behar-Cohen F. Postoperative Ocular Inflammation: A Single Subconjunctival Injection of XG-102 Compared to Dexamethasone Drops in a Randomized Trial. Am J Ophthalmol 2017; 174:76-84. [PMID: 27810317 DOI: 10.1016/j.ajo.2016.10.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/21/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of XG-102 (brimapitide) compared to dexamethasone eye drops in the treatment of postoperative ocular inflammation. DESIGN Multicenter, randomized, parallel group, double-masked, noninferiority clinical trial. METHODS Patients who underwent anterior and posterior segments combined surgery or glaucoma surgery or complex posterior segment surgery were eligible to participate. Patients were administered a single subconjunctival injection of 250 μL XG-102 90 μg (n = 47) or 900 μg (n = 48) or placebo (n = 50) at the end of ocular surgery. Subconjunctival injection for each group (XG-102 90 μg, XG-102 900 μg, or placebo) was followed by eye drops instilled 4 times per day for 21 days with placebo, placebo, or dexamethasone solution, respectively. The primary outcome measure was anterior chamber cell grades at day 28 comparing XG-102 900 μg with dexamethasone. RESULTS The anterior cell grades for both XG-102 groups were noninferior to dexamethasone (-0.054 anterior cell grade [95% confidence interval -0.350-0.242]; P < .001 for noninferiority) for XG-102 900 μg and -0.086 anterior cell grade (95% confidence interval -0.214-0.385; P = .003 for noninferiority) for XG-102 90 μg. Rescue medication was introduced for 10 (21%), 7 (15%), and 2 (4%) patients allocated to the XG-102 90 μg, XG-102 900 μg, and dexamethasone groups, respectively. The difference between XG-102 90 μg and dexamethasone was statistically significant (P = .013). The number of patients for whom adverse events were reported and the nature of the events reported was similar between the 3 treatment groups. CONCLUSIONS A single subconjunctival injection of XG-102 at the end of ocular surgery is noninferior to dexamethasone eye drops in the treatment of postoperative ocular inflammation.
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Meireles A, Goldsmith C, El-Ghrably I, Erginay A, Habib M, Pessoa B, Coelho J, Patel T, Tadayoni R, Massin P, Atorf J, Augustin AJ. Efficacy of 0.2 μg/day fluocinolone acetonide implant (ILUVIEN) in eyes with diabetic macular edema and prior vitrectomy. Eye (Lond) 2017; 31:684-690. [PMID: 28085139 PMCID: PMC5437318 DOI: 10.1038/eye.2016.303] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 11/15/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose Limited data are available on the efficacy of the 0.2 μg/day fluocinolone acetonide (FAc) implant in eyes with prior vitrectomy. Here, we present a collection of 26 vitrectomized eyes treated with the 0.2 μg/day FAc implant. Methods Retrospective study involving six centers from four European countries analyzing the safety and efficacy data from patients (26 eyes from 25 patients) with DME and a prior vitrectomy that had been treated with one 0.2 μg/day FAc implant. Results Prior intravitreal therapies included anti-VEGF (mean, 3.8 injections) and steroids (mean, 1.9 injections). Pars plana vitrectomy (PPV) was performed in these eyes primarily for abnormalities of vitreoretinal interface, followed by proliferative diabetic retinopathy and vitreous hemorrhage. The 0.2 μg/day FAc implant was injected 24.2 months, on average, after PPV and the mean duration of follow-up after injection was 255 days (range, 90 to 759 days). The mean change in BCVA was +11.7 ETDRS letters (range, −19 to +40 letters; P<0.0004) and the mean change in central foveal thickness (CFT) was −233.5 μm (range, −678 to 274 μm; P<0.0001). The mean change in IOP from baseline at the last visit was +1.4 mm Hg (range, −9 to +8 mm Hg; P=0.0090). Eight eyes initiated or continued IOP lowering medications. Conclusions These data suggest the 0.2 μg/day FAc implant is effective in vitrectomized patients with an acceptable safety profile. Further studies are still required to confirm the current findings and to assess the effect of the 0.2 μg/day FAc implant over a longer period of follow-up.
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Affiliation(s)
- A Meireles
- Unit of Ophthalmology, CHP-Hospital Santo António, Porto, Portugal.,Unit of Ophthalmology, Universidade do Porto-Instituto Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - C Goldsmith
- Unit of Ophthalmology, James Paget University Hospital, Great Yarmouth, UK
| | - I El-Ghrably
- Unit of Ophthalmology, James Cook University Hospital, Middlesbrough, UK
| | - A Erginay
- Unit of Ophthalmology, Lariboisiere University hospital, Paris, France
| | - M Habib
- Unit of Ophthalmology, Sunderland Eye Hospital, Sunderland, UK
| | - B Pessoa
- Unit of Ophthalmology, CHP-Hospital Santo António, Porto, Portugal
| | - J Coelho
- Unit of Ophthalmology, CHP-Hospital Santo António, Porto, Portugal
| | - T Patel
- Unit of Ophthalmology, James Paget University Hospital, Great Yarmouth, UK
| | - R Tadayoni
- Unit of Ophthalmology, Lariboisiere University hospital, Paris, France
| | - P Massin
- Unit of Ophthalmology, Lariboisiere University hospital, Paris, France
| | - J Atorf
- Department of Ophthalmology, Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - A J Augustin
- Department of Ophthalmology, Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany
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47
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Soudier G, Gaudric A, Gualino V, Massin P, Nardin M, Tadayoni R, Speeg-Schatz C, Gaucher D. Macular Choroidal Thickness in Myopic Eyes with and without a Dome-Shaped Macula: A Case-Control Study. Ophthalmologica 2016; 236:148-153. [DOI: 10.1159/000450556] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 08/31/2016] [Indexed: 11/19/2022]
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48
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Massin P, Delory T, Lhotellier L, Pasquier G, Roche O, Cazenave A, Estellat C, Jenny JY. Infection recurrence factors in one- and two-stage total knee prosthesis exchanges. Knee Surg Sports Traumatol Arthrosc 2016; 24:3131-3139. [PMID: 26611899 DOI: 10.1007/s00167-015-3884-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/12/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE Revision of infected total knee replacements (TKR) is usually delayed for a period in which the joint space is filled with an antibiotic-loaded acrylic spacer. In contrast, one-stage re-implantation supposes immediate re-implantation. Formal comparisons between the two methods are scarce. A retrospective multi-centre study was conducted to investigate the effects of surgery type (one-stage vs. two-stage) on cure rates. It was hypothesised that this parameter would not influence the results. METHOD All infected TKR, treated consecutively between 2005 and 2010 by senior surgeons working in six referral hospitals, were included retrospectively. Two hundred and eighty-five patients, undergoing one-stage or two-stage TKR, with more than 2-year follow-up (clinical and radiological) were eligible for data collection and analysis. Of them, 108 underwent one-stage and 177 received two-stage TKR. Failure was defined as infection recurrence or persistence of the same or unknown pathogens. Factors linked with infection recurrence were analysed by uni- and multi-variate logistic regression with random intercept. RESULTS Factors associated with infection recurrence were fistulae (odds ratio (OR) 3.4 [1.2-10.2], p = 0.03), infection by gram-negative bacteria (OR 3.3 [1.0-10.6], p = 0.05), and two-stage surgery with static spacers (OR 4.4 [1.1-17.9], p = 0.04). Gender and type of surgery interacted (p = 0.05). In men (133 patients), type of surgery showed no significant linkage with infection recurrence. In women (152 patients), two-stage surgery with static spacers was associated independently with infection recurrence (OR 5.9 [1.5-23.6], p = 0.01). Among patients without infection recurrence, International Knee Society scores were similar between those undergoing one-stage or two-stage exchanges. CONCLUSION Two-stage procedures offered less benefit to female patients. It suggests that one-stage procedures are preferable, because they offer greater comfort without increasing the risk of recurrence. Routine one-stage procedures may be a reasonable option in the treatment of infected TKR. LEVEL OF EVIDENCE III.
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Affiliation(s)
- P Massin
- Department of Orthopaedic Surgery, Hôpital Bichat Claude Bernard, Université Paris-Diderot, 46 rue Henri Huchard, 75877, Paris Cedex 18, France. .,EA 7334 Recherche Clinique Coordonnée Ville-Hôpital, Méthodologies et Société, Université Paris-Diderot, Sorbonne Paris Cité, 75010, Paris, France.
| | - T Delory
- Department of Epidemiology and Clinical Research, Hôpitaux Universitaires Paris Nord Val de Seine, Site Bichat, 46, rue Henri-Huchard, 75877, Paris Cedex 18, France.,INSERM, CIC-EC 1425, 75018, Paris, France
| | - L Lhotellier
- Groupe Hospitalier Diaconesse Croix Saint Simon, 125 rue d'Avron, 75020, Paris, France
| | - G Pasquier
- Hôpital Universitaire Roger Salengro, 59037, Lille, France
| | - O Roche
- Centre Chirurgical Emile Gallé, 49 rue Hermite, 54000, Nancy, France
| | - A Cazenave
- Institut Calot, rue du Docteur Calot, 62600, Berck Sur Mer, France
| | - C Estellat
- Department of Epidemiology and Clinical Research, Hôpitaux Universitaires Paris Nord Val de Seine, Site Bichat, 46, rue Henri-Huchard, 75877, Paris Cedex 18, France.,INSERM, CIC-EC 1425, 75018, Paris, France
| | - J Y Jenny
- Centre de Chirurgie Orthopédique et de la Main, Hôpitaux Universitaires de Strasbourg, 10 Avenue Baumann, 67400, Illkirch-Graffenstaden, France
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Gabrielle P, Massin P, Kodjikian L, Bron A, Creuzot C. Incidence of macular oedema following pan-retinal photocoagulation using a multi-spot semi-automated pattern-scanning laser in one sit versus 4 monthly sits in mild proliferative diabetic retinopathy or pre-proliferative diabetic retinopathy. Acta Ophthalmol 2016. [DOI: 10.1111/j.1755-3768.2016.0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Callanan DG, Loewenstein A, Patel SS, Massin P, Corcóstegui B, Li XY, Jiao J, Hashad Y, Whitcup SM. A multicenter, 12-month randomized study comparing dexamethasone intravitreal implant with ranibizumab in patients with diabetic macular edema. Graefes Arch Clin Exp Ophthalmol 2016; 255:463-473. [PMID: 27632215 DOI: 10.1007/s00417-016-3472-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [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: 04/26/2016] [Revised: 06/28/2016] [Accepted: 08/09/2016] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To evaluate whether treatment with dexamethasone intravitreal implant (DEX implant) 0.7 mg every 5 months provides a similar average change in best-corrected visual acuity (BCVA) from baseline as ranibizumab 0.5 mg administered as per its European Summary of Product Characteristics in patients with diabetic macular edema (DME). METHODS This was a multicenter, open-label, 12-month, randomized, parallel-group, noninferiority study in patients with DME (one eye/patient). The primary efficacy measure was BCVA using the Early Treatment Diabetic Retinopathy Study (ETDRS) method. Secondary efficacy measures included area of leakage on fluorescein angiography and central retinal thickness (CRT) on optical coherence tomography. RESULTS Baseline patient characteristics were similar in the two treatment groups (DEX implant, n = 181; ranibizumab, n = 182); mean DME duration was ∼33 months. The mean average BCVA change from baseline over 12 months was 4.34 letters with DEX implant and 7.60 letters with ranibizumab. The lower limit of the 95 % confidence interval of the between-group difference was -4.74 letters, and therefore, DEX was demonstrated to be noninferior to ranibizumab based on the prespecified noninferiority margin of 5 letters. At monthly follow-up visits, the percentage of patients with ≥15-letter BCVA gain from baseline ranged from 7.2 to 17.7 % with DEX implant and 4.4 to 26.9 % with ranibizumab. Both DEX implant and ranibizumab effectively reduced CRT and reduced the area of fluorescein leakage. Between-group differences in change from baseline CRT favored DEX implant at 1, 2, 6, and 7 months (p ≤ 0.007) and ranibizumab at 4, 5, 9, and 10 months (p < 0.001); the decrease in fluorescein leakage area was greater with DEX implant than ranibizumab at month 12 (p < 0.001). Ocular adverse events in the study eye were more frequent in the DEX implant group because of the occurrence of intraocular pressure (IOP) increases and cataract. IOP increases were transient and generally managed with topical medication. CONCLUSIONS Both DEX implant and ranibizumab were well tolerated and improved BCVA and anatomic outcomes in patients with DME. DEX implant met the a priori criterion for noninferiority to ranibizumab in average change from baseline BCVA over 12 months. Noninferiority was achieved with an average of 2.85 DEX implant injections and 8.70 ranibizumab injections per patient.
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Affiliation(s)
- David G Callanan
- Texas Retina Associates, 801 W Randol Mill Rd, Suite 101, Arlington, TX, 76012, USA.
| | | | | | - Pascale Massin
- Paris Diderot University, Lariboisière Hospital, Paris, France
| | | | | | | | | | - Scott M Whitcup
- Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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