Biomedical subjects

A Zourdani

Publications and source records attributed to A Zourdani.

7 recordsLinked to original sources

PubMed2006

[SPA-1: semiology for phenotyping AMD: precursors].

PURPOSE: A reliable classification of AMD subgroups is necessary prior to any genetic or clinical investigation. For this purpose, we evaluated a selected list of items for AMD based on color photographs of the fundus but also on fluorescein and ICG angiographies and OCT. The first step (SPA-1) is to evaluate the interobserver agreement for AMD precursors. METHODS: The 30 items for AMD precursors, choroidal neovascularization and atrophy, were chosen from the literature. We selected 20 eyes from 20 consecutive patients affected by various forms of these precursors from the prospective NAT-2 study. Grading was based on color photographs of fundus, red-free frames, and fluorescein angiography. For each eye, five grids were filled in by four independent, experienced readers from our reading center and one expert. Within-subject variance was studied. RESULTS: Within subject variance showed the greatest agreement between graders for drusenoid pigment epithelial detachment (variance=0.000). The worst value for within subject variance (0.255) was recorded for the item "intermediate drusen between 5 and 20." CONCLUSION: This evaluation of our first grid for AMD precursors shows high agreement between graders for most of the items. The item with the lowest agreement should be modified according to the comments of the physicians. This grid could be implemented for phenotypic classification of ARM and AMD in future clinical or genetic studies.

Feasibility Studies↗

PubMed2006

[Surgical treatment of persistent macular edema in retinal vein occlusion].

INTRODUCTION: Persistent macular edema (ME) is the main cause of poor visual outcome in nonischemic retinal vein occlusion (RVO). The aim of this study was to evaluate the results of surgery in this disorder. PATIENTS AND METHODS: Retrospective nonrandomized comparative pilot study. Visual acuity measurement, fluorescein angiography, and optical coherence tomography were performed before and after treatment, at 3 months, 6 months, and 1 year. RESULTS: The study included 42 eyes: 15 eyes underwent vitrectomy with peeling of the posterior hyaloid and/or the internal limiting membrane, 19 received intravitreous injection of triamcinolone (IVT), and four had a combination of both treatments. In the vitrectomy group, 63% of the eyes showed a progressive decrease of ME throughout the year of follow-up (p<0.05 at 1 month and 1 year) and an increase in visual acuity (p<0.05 at 3 and 6 months); no complication occurred. In the IVT group, the eyes showed a rapid improvement in vision and in ME at 1 month (p=0.007 and p=0.001, respectively) but with a frequent ME recurrence at 4 months; however, 31% of eyes showed durable improvement. Complications after IVT were pseudo-endophthalmitis (one eye), transient hypertony (53%), and a full-thickness macular hole (one eye). In the group treated with vitrectomy combined with IVT, ME decreased rapidly and durably, but vision did not improve in this small subgroup of long-lasting RVO with prior pigment epithelial changes. CONCLUSION: In some eyes, vitrectomy seems to have a more durable effect than IVT alone. Further randomized and controlled studies are needed to confirm these results and to compare them to the natural course of the disease.

Adult↗

PubMed2004

[Optical coherence tomography and ARMD].

Optical coherent tomography examination (OCT) is a new medical diagnostic imaging modality analogous to ultrasound B-mode imaging, able to perform anteroposterior cross-sectional imaging of interior tissues and is useful in clinical practice in ARMD. The combination of fluorescein and ICG angiography imaging with OCT imaging will bring additional information for all clinical forms of ARMD. Many patterns and images are easy to identify, including serous retinal detachment, diffuse or cystoid retinal edema, serous or fibrovascular retinal pigment epithelium detachment with or without retinal pigment epithelium (RPE) tears and fibrosis. Other symptoms are more difficult to detect and to analyze and will need to be combined with other imaging techniques: the presence of choroidal new vessels and their localisation related to the center of the fovea and the RPE; the association of different lesions (hemorrhages, exudation, fibrosis, anastomosis and PE detachment) and recognition of less frequent lesions such as polypoidal choroidal vasculopathy. During follow-up, choroidal new vessels may be shown with different modalities. OCT examination could detect and localize these lesions, helping to determine the best management strategy. OCT examination appears to be particularly useful for both detection of persistent fluid and reabsorption and reattachment of the retina.

Aged↗

PubMed2001

Effect of isovolemic hemodilution in central retinal vein occlusion.

BACKGROUND: Hemorheologic abnormalities have recently been shown to play a role in the pathogenesis of retinal vein occlusion (RVO), and several studies have demonstrated the efficacy of isovolemic hemodilution in these eyes. This study was designed to investigate further the effects of hemodilution, with regard to the duration of symptoms before the treatment. METHODS: In a prospective study, 142 eyes with central or hemicentral RVO were treated by isovolemic hemodilution. The target hematocrit value was 35%. Mean duration of follow-up was 10 months. A subgroup of 50 patients treated within 2 weeks of the onset of symptoms was compared first with patients treated later by hemodilution, and then retrospectively with controls with central RVO and without hemodilution. RESULTS: Hemodilution therapy resulted in a decrease in hematocrit level from 42% to 32% on average, with no major side effect. After treatment, a significant decrease was observed in hemorheologic parameters (fibrinogen, erythrocyte aggregation), except in plasma viscosity. Retinal circulation times were significantly shortened. Visual acuity (VA) improvement immediately after treatment (in 43% of eyes) was correlated with better final visual outcome (P<0.05). At the end of follow-up, VA was better in patients treated within the first 2 weeks than in those treated later and in controls (41% had VA of 20/40 or more in the early-treatment group versus 23% in the late-treatment group, P<0.01). Final retinal ischemia was also greater in the late-treatment group and in controls. Hemodilution in 12 patients with long-standing RVO and macular edema was ineffective. CONCLUSION: Our study is consistent with previous investigations that confirmed the efficacy of isovolemic hemodilution in RVO on hemorheologic parameters, retinal circulation times and final VA. It also underlined strongly the benefit of early treatment within the first 2 weeks of the RVO. Further studies are required to confirm these results.

Adolescent↗

PubMed1996

Prognostic factors for retinal vein occlusion: prospective study of 175 cases.

BACKGROUND: The prognosis of retinal vein occlusion is highly unpredictable because nonischemic types may convert into ischemic types within the first months. This study was designed to identify epidemiologic characteristics of the different types of retinal vein occlusion, their visual outcome, and their prognostic factors. METHODS: The authors analyzed prospectively the data from patients who have had retinal vein occlusion with complete medical and biologic examination, including fluorescein angiography, and a 1-year follow-up. RESULTS: One hundred seventy-five retinal vein occlusion eyes consisted of 120 central retinal vein occlusions (CRVO), 7 hemicentral occlusions, and 48 branch occlusions. In initially nonischemic CRVO eyes, retinal ischemia developed in 54%. The study of prognostic factors in the CRVO group showed that older age, male sex, and the number of risk factors (systemic vascular risk factors and glaucoma) were correlated with a poor visual outcome and with the development of retinal ischemia, as well as baseline visual acuity, initial extent of retinal ischemia, and rheologic findings (hematocrit, fibrinogen, and erythrocyte aggregation levels). Logistic regression underlined the prognostic role of sex, the number of risk factors, erythrocyte aggregation, and initial clinical features. Persistent macular edema was shown to be associated with hyperlipidemia and cardiovascular history, and inversely correlated to glaucoma. CONCLUSION: Because clinical characteristics of CRVO may worsen, the authors' results provide a basis to predict visual outcome by taking into account epidemiologic and rheologic findings. A careful follow-up of these patients is recommended.

Adult↗

PubMed1994

A randomized, double-masked study on the treatment of retinal vein occlusion with troxerutin.

Hemorheologic factors probably play a role in the pathogenesis and prognosis of retinal vein occlusion. Accordingly, we designed a prospective, randomized, double-masked study to evaluate the effect of troxerutin, a rheologic drug, on retinal vein occlusion. Fifty-three patients were included, 27 with central retinal vein occlusion and 26 with branch retinal vein occlusion. They were randomly assigned for treatment with either troxerutin or a placebo. All subjects were similar in age, gender, associated diseases, hemorheologic values, and clinical severity of the retinal vein occlusion. At the end of follow-up, members of the troxerutin-treated group, as compared with the placebo group, showed significant improvement in visual acuity (P = .03), macular threshold (P = .01), retinal circulation times (P = .04), and macular edema (P = .05). Furthermore, they had diminished progression of ischemia (P = .05) and decreased red blood cell aggregability (P = .006) when compared with the controls. These encouraging preliminary results obtained with a rheologic treatment attest to the pathogenic role of blood viscosity in retinal vein occlusion and suggest that a large-scale randomized study should be conducted.

Adult↗

PubMedDate not supplied

Macular grid photocoagulation in persistent macular edema due to central retinal vein occlusion.

AIM: Macular edema is still the main cause of poor visual prognosis in central retinal vein occlusion (CRVO). This study was designed to establish whether grid photocoagulation is effective in the management of this disorder. METHODS: The records of 16 patients who had undergone macular grid photocoagulation for persistent macular edema due to CRVO were reviewed retrospectively. Pre-treatment visual acuity ranged from 20/400 to 20/40, and laser treatment was done six months or more after the onset of the disease. RESULTS: Biomicroscopy and fluorescein angiography showed the improvement or disappearance of macular edema in 14/16 patients (87.5%). Improved visual acuity was observed in eight (50%) and no improvement or reduced vision in the other eight (50%). A poorer prognosis was statistically correlated with older age (p < 0.03), macular ischemia (p < 0.001), foveal avascular zone larger than 1/2 disc diameter (p < 0.05) and pigmentary clumps in the foveal area (p < 0.05). Laser treatment was ineffective for most patients with systemic vascular risk factors and pre-treatment visual acuity below 20/200. CONCLUSION: Macular grid photocoagulation may be effective for drying up, or at least reducing, macular edema due to CRVO and some improvement of vision can be expected in half the cases.

Adult↗