Lausanne, Switzerland
Lausanne, Switzerland

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Casparis H.,Jules Gonin Eye Hospital | Wolfensberger T.J.,Jules Gonin Eye Hospital | Becker M.,Triemli Hospital Zurich | Eich G.,Triemli Hospital Zurich | And 3 more authors.
Retina | Year: 2014

Purpose: To evaluate the incidence of presumed endophthalmitis (EO) after intravitreal injection (IVI) of anti-vascular endothelial growth factor agents performed in the operating room. Methods: Retrospective study at 2 Swiss eye hospitals between 2004 and 2012. Hospital records were used to identify patients treated with an IVI of an anti-vascular endothelial growth factor agent between 2004 and 2012 and those treated for EO, defined as any intraocular inflammation treated with intravitreal antibiotics. All IVIs were performed using standard sterile technique in a Swiss Class 1 operating room. No patient received preinjection topical antibiotics. Postinjection topical antibiotics were used only in one hospital. Results: A total of 40,011 IVIs were performed at the 2 centers during the study period. Of the IVIs, ranibizumab was injected in 36,398 (91%), bevacizumab in 3,518 (9%), aflibercept in 89 (0.2%), and pegaptanib in 6 (<0.1%). Three cases of post-IVI presumed EO occurred, yielding a combined incidence of 0.0075% per injection (95% confidence interval: 0.0026-0.0220%) or 1 case per 13,337 IVIs. Two of the three cases of EO occurred in patients using post-IVI antibiotics. All three cases followed ranibizumab injection and were culture negative by anterior chamber tap or vitreous biopsy. Conclusion: The risk of EO after IVI performed under the sterile conditions of the operating room was very low. Copyright © 2014 by Ophthalmic Communications Society, Inc.


Francis J.H.,Sloan Kettering Cancer Center | Francis J.H.,Cornell University | Abramson D.H.,Sloan Kettering Cancer Center | Abramson D.H.,Cornell University | And 5 more authors.
Ophthalmology | Year: 2015

Purpose To evaluate the clinical characteristics of the 3 classifications of vitreous seeds in retinoblastoma - dust (class 1), spheres (class 2), and clouds (class 3) - and their responses to intravitreal melphalan. Design Retrospective, bi-institutional cohort study. Participants A total of 87 patient eyes received 475 intravitreal injections of melphalan (median dose, 30 μg) given weekly, a median of 5 times (range, 1-12 times). Methods At presentation, the vitreous seeds were classified into 3 groups: dust, spheres, and clouds. Indirect ophthalmoscopy, fundus photography, ultrasonography, and ultrasonic biomicroscopy were used to evaluate clinical response to weekly intravitreal melphalan injections and time to regression of vitreous seeds. Kaplan-Meier estimates of time to regression and ocular survival, patient survival, and event-free survival (EFS) were calculated and then compared using the Mantel-Cox test of curve. Main Outcome Measures Time to regression of vitreous seeds, patient survival, ocular survival, and EFS. Results The difference in time to regression was significantly different for the 3 seed classes (P < 0.0001): the median time to regression was 0.6, 1.7, and 7.7 months for dust, spheres, and clouds, respectively. Eyes with dust received significantly fewer injections and a lower median and cumulative dose of melphalan, whereas eyes with clouds received significantly more injections and a higher median and cumulative dose of melphalan. Overall, the 2-year Kaplan-Meier estimates for ocular survival, patient survival, and EFS (related to target seeds) were 90.4% (95% confidence interval [CI], 79.7-95.6), 100%, and 98.5% (95% CI, 90-99.7), respectively. Conclusions The regression and response of vitreous seeds to intravitreal melphalan are different for each seed classification. The vitreous seed classification can be predictive of time to regression, number, median dose, and cumulative dose of intravitreal melphalan injections required. © 2015 American Academy of Ophthalmology.


De Smedt S.,Center du Glaucome | Mermoud A.,Center du Glaucome | Schnyder C.,Center du Glaucome | Schnyder C.,Jules Gonin Eye Hospital
Journal of Glaucoma | Year: 2012

PURPOSE: To evaluate the tolerability, comfort, and reliability of the signal transmission of an ocular Sensor used for 24-hour intraocular pressure fluctuation monitoring in humans. PATIENTS AND METHODS: In this uncontrolled open trial involving 10 healthy volunteers, an 8.7-mm radius prototype ocular telemetry Sensor (SENSIMED Triggerfish, Lausanne, Switzerland) and an orbital bandage containing a loop antenna were applied and connected to a portable recorder after full eye examination. Best-corrected visual acuity and position, surface wetting ability, and mobility of the Sensor were assessed after 5 and 30 minutes, 4, 12, and 24 hours. Subjective wearing comfort was scored and activities documented in a logbook. After Sensor removal, a full eye examination was repeated and the recorded signal analyzed. RESULTS: The comfort score was high and did not fluctuate significantly over time. The mobility of the Sensor was limited across follow-up visits and its surface wetting ability remained good. Best-corrected visual acuity was significantly reduced during Sensor wear and immediately after its removal (from 1.07 before, to 0.85 after, P value 0.008). Three subjects developed a mild, transient corneal abrasion. In all but 1 participant, we obtained usable data of a telemetric signal recording with sufficient sensitivity to depict ocular pulsation. CONCLUSIONS: This 24-hour trial has encouraging results on the tolerability and functionality of the ocular telemetric Sensor for intraocular pressure fluctuation monitoring. Further studies with different Sensor radii conducted on a larger study population are needed to improve comfort, precision, and interpretation of the telemetric signal. Copyright © 2012 by Lippincott Williams & Wilkins.


Vincent A.,University of Toronto | Munier F.L.,Jules Gonin Eye Hospital | Vandenhoven C.C.,University of Toronto | Wright T.,University of Toronto | And 2 more authors.
Retina | Year: 2012

Purpose: To describe the clinical, spectral-domain optical coherence tomography and electrophysiological features of C1QTNF5-associated late-onset retinal degeneration in a molecularly confirmed pedigree. Methods: Five members of a family participated, and affected individuals (n = 4) underwent detailed ophthalmologic evaluation including fundus autofluorescence and spectral-domain optical coherence tomography imaging and electroretinography. Electrooculography was performed in three individuals. Results: The visual acuity was initially normal and worsened with time. Anterior segment abnormalities included peripupillary iris atrophy and long anterior insertion of zonules. Peripapillary atrophy, drusenoid deposition, and scalloped sectorial chorioretinal atrophy were observed in all older individuals (n = 3). Fundus autofluorescence demonstrated hypofluorescent areas corresponding to regions of chorioretinal atrophy. The spectral-domain optical coherence tomography demonstrated multiple areas of retinal pigment epithelium-Bruch membrane separation with intervening homogeneous deposition that corresponded to the drusenoid lesions and areas of chorioretinal atrophy. Electrooculography was normal in one individual and showed abnormally low dark trough measures in older individuals (n = 2). Electroretinography was normal in early stages (n = 1), but showed marked abnormalities in the rod system (n = 3), which was predominantly inner retinal (n = 2) in late stages. Conclusion: Late-onset retinal degeneration is a progressive degeneration, and anterior segment abnormalities present early. The widespread sub-retinal pigment epithelium deposition seen on spectral-domain optical coherence tomography in older individuals appears to be a characteristic in late stages. Electrooculography demonstrates abnormalities only in late stages of the disease.


Oleszczuk J.D.,Jules Gonin Eye Hospital | Bergin C.,Jules Gonin Eye Hospital | Sharkawi E.,Jules Gonin Eye Hospital
Investigative Ophthalmology and Visual Science | Year: 2012

PURPOSE. To investigate the effect of intraocular straylight (IOS) induced by white opacity filters (WOF) on threshold measurements for stimuli employed in three perimeters: standard automated perimetry (SAP), pulsar perimetry (PP) and the Moorfields motion displacement test (MDT). METHODS. Four healthy young (24-28 years old) observers were tested six times with each perimeter, each time with one of five different WOFs and once without, inducing various levels of IOS (from 10% to 200%). An increase in IOS was measured with a straylight meter. The change in sensitivity from baseline was normalized, allowing comparison of standardized (z) scores (change divided by the SD of normative values) for each instrument. RESULTS. SAP and PP thresholds were significantly affected (P < 0.001) by moderate to large increases in IOS (50%-200%). The drop in motion displacement (MD) from baseline with WOF 5, was approximately 5 dB, in both SAP and PP which represents a clinically significant loss; in contrast the change in MD with MDT was on average 1 minute of arc, which is not likely to indicate a clinically significant loss. CONCLUSIONS. The Moorfields MDT is more robust to the effects of additional straylight in comparison with SAP or PP. © 2012 The Association for Research in Vision and Ophthalmology, Inc.


Clarke L.A.L.,University of Lausanne | Guex-Crosier Y.,Jules Gonin Eye Hospital | Hofer M.,University of Lausanne
Clinical and Experimental Rheumatology | Year: 2013

Objectives The aim of the present study is to investigate the demographics, aetiologies, complications, treatments and visual outcomes in paediatric uveitis patients in the French-speaking part of Switzerland. Methods Chart review of all patients diagnosed with uveitis before the age of 16 years, presenting to two tertiary referral centres (uveitis and paediatric rheumatology clinics) in Lausanne, Switzerland, between 2000 and 2009. Results Seventy-nine children (37 girls) were identified, 62 living in Switzerland, 15 in Europe and 2 in North Africa. Median age at first symptoms was 9.0 years (range 1.5-15.8 years), with a median follow-up time of 1.8 years (0-8 years). Both eyes were involved in 51 patients (64.6%). The course was acute in 30.4%, chronic in 60.8% and recurrent in 8.9%. Anterior uveitis occurred in 39.2%, intermediate in 32.9%, posterior in 22.8% and panuveitis in 5.1%. The three main diagnoses were idiopathic uveitis (34.2%), JIA-related uveitis (22.8%) and toxoplasmic retinochoroiditis (15.2%). During the last follow-up visit, the visual acuity (VA) was =8/10 in 72% of all eyes with a measurable VA. Cataract (8%), ocular hypert-ension/glaucoma (8%) and macular fibrosis (4%) were the three most common severe complications. Systemic steroids were given to 56% and biological agents to 24% of patients with inflammatory uveitis. Conclusion Uveitis in children can be a devastating disease. A strict classification of aetiologies and a tight collaboration between paediatric rheumatologists and ophthalmologists are important to ensure early control of ocular inflammation and improve long-term visual prognosis. ©Copyright Clinical and Experimental Rheumatology 2013.


Munier F.L.,Jules Gonin Eye Hospital
Ophthalmic Genetics | Year: 2014

Retinoblastoma has the unique capacity to accelerate its own intra-ocular propagation by adopting semi-solid or even liquid growth properties through seeding. Until recently, the presence of any degree of seeding was mostly incompatible with successful conservative management, due to the multiresistant nature of the seeds. Surprisingly, this well-recognized retinoblastoma behavior has not undergone any detailed description of seeding patterns and anatomic sites. In this paper, we describe the phenotypic variability of seeds across the four possible intraocular seeding compartments and classify them into three fundamental types: namely dust, spheres, and clouds. We also provide an overview of the different therapeutic strategies developed for seeding, with special attention to intravitreal chemotherapy as the treatment of choice for vitreous and retro-hyaloid seeding. Finally, we propose criteria to enable assessment of the response to treatment by reporting seed regression patterns, as well as a clinical grading system for the retinal toxicity observed following intravitreal melphalan. © Informa Healthcare USA, Inc.


Sharkawi E.,Jules Gonin Eye Hospital | Oleszczuk J.D.,Jules Gonin Eye Hospital | Bergin C.,Jules Gonin Eye Hospital | Zografos L.,Jules Gonin Eye Hospital
British Journal of Ophthalmology | Year: 2012

Introduction: Melanoma of the iris and ciliary body may be associated with secondary glaucoma. Treatment with proton beam radiotherapy (PBRT) to the anterior segment can also elevate intraocular pressure (IOP), resulting in uncontrolled glaucoma, often requiring enucleation. This is the first prospective study of Baerveldt aqueous shunts in irradiated eyes with anterior uveal melanoma (AUM; affecting the iris or ciliary body). Methods: Thirty-one eyes with uncontrolled IOP following anterior segment PBRT treatment for AUM were prospectively recruited to undergo Baerveldt shunt implantation. Postoperative examinations were performed on day 1; weeks 1, 3, 6, 9; months 3, 6, 9, 12 and annually thereafter. Surgical success was defined as IOP 21 mm Hg or less and 20% reduction from baseline. All complications were recorded. Results: Mean follow-up was 15.7 months (SD ±8.3 months). Mean interval from irradiation to shunt implantation was 2.5 years. Mean preoperative IOP was 31.0 (±10.3) mm Hg; mean IOP at last visit was 15.0 (±5.0) mm Hg; mean pre-operative glaucoma medications were 3.3 (±1.3); postoperatively 0.7 (±1.3) glaucoma medications. Surgical success rate was 86% using glaucoma medications. Four eyes had minor postoperative complications, none of which were sight threatening. There were no local tumour recurrences or systemic metastases. There were no enucleations caused by ocular hypertension. Conclusions: Baerveldt shunts were effective in lowering IOP, with few complications, in eyes treated with total anterior segment irradiation for AUM.


Ferrini W.,University of Lausanne | Aubert V.,University of Lausanne | Balmer A.,University of Lausanne | Munier F.L.,University of Lausanne | And 2 more authors.
Pediatrics | Year: 2013

Many reports associating uveitis after vaccination have been reported, including 2 cases after measles, mumps, and rubella (MMR) vaccine. We report the case of a 12-month-old girl who developed a unilateral anterior uveitis with rubeosis and cataract 3 months after an MMR vaccination at 9 months of age. Aqueous humor analysis showed the presence of more rubella-specific immunoglobulin G in the affected eye than in the unaffected one. This is the second report showing an association between MMR vaccine and anterior uveitis and the first supported by the presence of intraocular rubella antibodies. © 2013 by the American Academy of Pediatrics.


Munier F.L.,Jules Gonin Eye Hospital | Soliman S.,Jules Gonin Eye Hospital | Soliman S.,Alexandria University | Moulin A.P.,Jules Gonin Eye Hospital | And 3 more authors.
British Journal of Ophthalmology | Year: 2012

Background: The preservation of globe integrity has always been a major concern during the treatment of retinoblastoma for fear of extraocular or metastatic spread. Intravitreal chemotherapy has been attempted as a desperate salvage therapy only for eyes with refractory retinoblastoma. Published data on the safety and efficacy of this route are, however, limited. Methods: A modified technique of intravitreal injection in eyes with retinoblastoma is described. All children with retinoblastoma who received one or more intravitreal injections using this technique were retrospectively reviewed concerning ocular complications of the injection procedure as well as clinical or histopathological evidence of tumour spread. Results: 30 eyes of 30 children with retinoblastoma received a total of 135 intravitreal injections, with a median follw-up duration of 13.5 months. No extraocular spread was seen on clinical follow-up in any patients and there was no tumour contamination of the retrieved entry sites histopathologically analysed among the five enucleated eyes. No significant ocular side effects were observed except transient localised vitreous haemorrhage (3/135). Conclusion: This technique is potentially safe and effective at a low cost and may play a promising role, especially in the treatment of recurrent and/or resistant vitreous disease in retinoblastoma, as an alternative to enucleation and/or external beam radiotherapy. However, this treatment should not replace the primary standard of care of retinoblastoma and should not be considered in group E eyes. Its application should be approved by an ophthalmological-oncological team and it should be performed by an experienced eye surgeon in a tertiary referral centre after careful selection of a tumour-free injection site.

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