A. Zourdani

Centre Hospitalier Intercommunal Creteil, Créteil, Île-de-France, France

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Publications (48)39.19 Total impact

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    ABSTRACT: Purpose: To report unusual presentations of type 2A idiopathic macular telangiectasia (IMT). Methods: A retrospective analysis of disease presentation was conducted in 32 patients with type 2A IMT. All patients underwent a complete ophthalmological examination, including spectral domain optical coherence tomography (SD-OCT), fluorescein angiography (FA) and indocyanine green angiography (ICGA). Results: Three out of 32 study patients showed the simultaneous presentation of type 2 IMT and other retinal diseases. In the first patient, the ophthalmological examination revealed a proliferative IMT associated with late-onset Stargardt disease. The second patient presented bilateral nonproliferative IMT and chronic serous chorioretinopathy in the left eye. The examination of the third patient revealed basal laminar drusen and soft drusen associated with IMT in both eyes. Conclusions: Type 2 IMT may represent an unusual presentation of Stargardt disease, chronic serous chorioretinopathy and basal laminar drusen. These presentations are most likely coincidental and highlight the importance of FA, ICGA and SD-OCT in the diagnosis and treatment of such cases. © 2013 S. Karger AG, Basel.
    Ophthalmologica 08/2013; · 1.41 Impact Factor
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    ABSTRACT: OBJECTIVE: To evaluate the efficacy of docosahexaenoic acid (DHA)-enriched oral supplementation in preventing exudative age-related macular degeneration (AMD). DESIGN: The Nutritional AMD Treatment 2 study was a randomized, placebo-controlled, double-blind, parallel, comparative study. PARTICIPANTS: Two hundred sixty-three patients 55 years of age or older and younger than 85 years with early lesions of age-related maculopathy and visual acuity better than 0.4 logarithm of minimum angle of resolution units in the study eye and neovascular AMD in the fellow eye. METHODS: Patients were assigned randomly to receive either 840 mg/day DHA and 270 mg/day eicosapentaenoic acid (EPA) from fish oil capsules or the placebo (olive oil capsules) for 3 years. MAIN OUTCOME MEASURES: The primary outcome measure was time to occurrence of choroidal neovascularization (CNV) in the study eye. Secondary outcome measures in the study eye were: incidence of CNV developing in patients, changes in visual acuity, occurrence and progression of drusen, and changes in EPA plus DHA level in red blood cell membrane (RBCM). RESULTS: Time to occurrence and incidence of CNV in the study eye were not significantly different between the DHA group (19.5±10.9 months and 28.4%, respectively) and the placebo group (18.7±10.6 months and 25.6%, respectively). In the DHA group, EPA plus DHA levels increased significantly in RBCM (+70%; P<0.001), suggesting that DHA easily penetrated cells, but this occurred unexpectedly also in the placebo group (+9%; P = 0.007). In the DHA-allocated group, patients steadily achieving the highest tertile of EPA plus DHA levels in RBCM had significantly lower risk (-68%; P = 0.047; hazard ratio, 0.32; 95% confidence interval, 0.10-0.99) of CNV developing over 3 years. No marked changes from baseline in best-corrected visual acuity, drusen progression, or geographic atrophy in the study eye were observed throughout the study in either group. CONCLUSIONS: In patients with unilateral exudative AMD, 3 years of oral DHA-enriched supplementation had the same effect on CNV incidence in the second eye as did the placebo. However, RBCM fatty acid measurements revealed that CNV incidence was significantly reduced in DHA-supplemented patients showing a steadily high EPA plus DHA index over 3 years. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
    Ophthalmology 02/2013; · 5.56 Impact Factor
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    ABSTRACT: PURPOSE:: To survey compliance with recommended intravitreal ranibizumab treatment protocols in daily clinical practice in France, with reference to outcomes. METHODS:: A retrospective, descriptive, observational study in patients with subfoveal wet age-related macular degeneration treated with ranibizumab. All historical data for the study period, including demographic, treatment, and disease details and visual acuity measurements (baseline, Month 3, and Month 12), were recorded retrospectively at least 12 months after the beginning of treatment. RESULTS:: In 551 patients followed by 16 ophthalmologists, 12 months of intravitreal ranibizumab treatment induced a mean visual acuity gain of 3.2 ± 14.8 Early Treatment Diabetic Retinopathy Study-equivalent letters. Fewer than 40% of patients received the recommended treatment of initial 3 monthly injections. More than 50% had to wait >8 days between diagnosis and treatment. At Month 3, visual acuity gain was greater in patients who had received recommended induction and in whom treatment was initiated quickly. At Month 12, the induction-related effect had largely disappeared but the time-to-treatment effect persisted. Patients had an average of 5.1 injections (2.6 during induction period). No patients were monitored monthly as stipulated in the guidelines. CONCLUSION:: Although poor compliance with recommendations has been reflected in mediocre outcomes, there is evidence that practice is improving.
    Retina (Philadelphia, Pa.) 12/2012; · 2.93 Impact Factor
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    ABSTRACT: To analyze the characteristics and the course of macular edema secondary to central retinal vein occlusion (CRVO) using optical coherence tomography (OCT) and to determine correlations between clinical, tomographic and angiographic data, in particular including retinal ischemia. In this retrospective study, 53 consecutive patients with CRVO were included. At each follow-up visit, patients underwent complete ophthalmological examination, including best-corrected visual acuity (BCVA) and OCT. Fluorescein angiography was performed at baseline and on demand during follow-up. 243 OCTs were analyzed. Mean age was 61 years and mean follow-up 13 months. The first structural change, observed very early after the onset of the occlusion, was a diffuse increase at the level of the outer nuclear layer without change at the level of the inner retina. This early change seemed characteristic of retinal vein occlusion. Cystoid spaces were subsequently observed in all retinal layers and were combined with serous retinal detachment in 51 %. During the first 6 months, central retinal thickness was higher in ischemic CRVO (mean, 691 μm) than in non-ischemic CRVO (mean, 440 μm, p < 0.01). In eyes with foveal thickness (central retinal thickness without subretinal fluid) of 700 μm or greater, peripheral ischemia was present in 69 % of eyes, final BCVA was 20/200 or less in 75 % and never reached 20/40 during follow-up. The integrity of the junction of the photoreceptors' inner and outer segments was correlated with a better prognosis (p < 0.05). Foveal thickness was inversely correlated to BCVA at each visit and could have a prognostic value. OCT examination in CRVO revealed useful data for the diagnosis of CRVO and its prognosis. The largest macular edemas seemed to be the hallmark of ischemic CRVO.
    International Ophthalmology 05/2012; 32(4):369-77.
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    ABSTRACT: Purpose. The possibility of applying long-lasting steroids, such as triamcinolone and subsequently dexamethasone implant, directly in the eye, without the systemic side effects observed after their oral or intravenous administration, aroused great enthusiasm among ophthalmologists.?Methods and Results. The SCORE study, a multicenter clinical trial, compared the efficacy and safety of 1-mg and 4-mg doses of preservative-free intravitreal triamcinolone with observation in central retinal vein occlusion (CRVO) participants with macular edema secondary to perfused CRVO. This study marked a turning point in the management of retinal vein occlusion (RVO), since it was the first report on an effective treatment of macular edema due to CRVO. But in branch retinal vein occlusion (BRVO), the SCORE study showed no difference in visual acuity for the standard care group compared with the triamcinolone groups; however, the rates of adverse events (particularly elevated intraocular pressure and cataract) were highest in the 4-mg group. The authors concluded that laser grid photocoagulation should remain the benchmark against which other treatments should be compared. The Geneva Study, a randomized, controlled, clinical trial, conducted to evaluate the safety and efficacy of an intravitreal implant that delivers sustained levels of dexamethasone (Ozurdex™), studied the largest group of RVO patients with macular edema (1267 patients), including 35% CRVO and 65% BRVO. The study demonstrated that this slow-release device could both reduce the risk of vision loss and improve the speed and incidence of visual improvement in eyes with macular edema secondary to CRVO and BRVO, with fewer side effects, such as elevation of intraocular pressure or cataract. Other ongoing studies evaluate the safety and efficacy of anti-vascular endothelial growth factor injection; preliminary results showed that these therapies are effective in decreasing macular edema and improving visual acuity, with fewer ocular adverse effects, but their duration of action seems limited.?Conclusions. These recent studies result in a great change in the management of macular edema from RVO. Unfortunately, long-term studies on safety and efficacy are not yet available, and further studies will have to show whether the short-term benefits are only transient or may finally lead to a long-lasting improvement in vision.
    European journal of ophthalmology 11/2010; 21(S6):37-44. · 0.91 Impact Factor
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    ABSTRACT: To evaluate the efficacy and the safety of intravitreal ranibizumab injection (Lucentis) in eyes with macular oedema secondary to central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO). The files of consecutive patients (34 eyes, 15 CRVO, 19 BRVO) were retrospectively analysed. Intravitreal injections of 0.5 mg ranibizumab were administered; retreatment was based on acuity visual changes and optical coherence tomography findings. Patients received 2-4 injections (mean, 2.1). Mean follow-up was 7 months. After the first injection, mean best-corrected visual acuity (BCVA) improved from 20/160 to 20/80 and mean central retinal thickness (CRT) decreased significantly from 549 to 301 μm (p < 0.01). For each injection, BCVA improvement was on average nine letters (p < 0.01) and macular oedema reduction was 195 μm CRT (p < 0.01). The decrease in CRT was similar in CRVO and BRVO, but the improvement in BCVA was larger in BRVO. No local or systemic adverse effect was detected. Final visual acuity was correlated to initial visual acuity and to visual acuity measured after the first injection. The change in CRT was correlated to the number of injections and to initial CRT. Intravitreal injections of ranibizumab appeared to be a safe and effective option in the treatment of macular oedema secondary to retinal vein occlusion. Nevertheless, because the natural course has demonstrated a possible improvement in vision in almost one quarter of affected eyes at 3 years, further controlled and prospective studies are necessary to compare this treatment to the natural course with a longer follow-up.
    Acta ophthalmologica 06/2010; 90(4):357-61. · 2.44 Impact Factor
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    ABSTRACT: Spectral Domain OCT (SD-OCT) instruments provide ophthalmologists with a significannt amount of new information.
    07/2009: pages 85-95;
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    ABSTRACT: New and extremely valuable information is now provided with Spectral Domain OCT (SD-OCT) due to the more rapid data acquisition.
    07/2009: pages 365-377;
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    ABSTRACT: Optical coherence tomography (OCT) is a noninvasive imaging technology that provides high-resolution cross-sectional images of tissue microstructures in vivo.
    07/2009: pages 67-83;
  • Journal Francais D Ophtalmologie - J FR OPHTALMOL. 01/2009; 32.
  • Journal Francais D Ophtalmologie - J FR OPHTALMOL. 01/2009; 32.
  • Journal Francais D Ophtalmologie - J FR OPHTALMOL. 01/2009; 32.
  • Journal Francais D Ophtalmologie - J FR OPHTALMOL. 01/2009; 32.
  • Journal Francais D Ophtalmologie - J FR OPHTALMOL. 01/2009; 32.
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    ABSTRACT: Atrophic form of “Dry AMD” is defined by areas of RPE atrophy, often resulting from regression of confluent soft drusen.
    01/2009;
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    ABSTRACT: Described for the first time in 1994 as an active and progressive form of AMD, chorioretinal anastomoses (CRA), constitute a unique entity among the various clinical forms of wet AMD (Coscas 1994, International Symposium on Fluorescein Angiography, Toronto). Chorioretinal anastomoses are active lesions and frequently involve both eyes.
    01/2009;
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    ABSTRACT: Over recent years, OCT has become an essential part of the examination in routine follow up for AMD to guide clinical practice and analyze the response to treatment. OCT examinations can clearly demonstrate the efficacy of treatment by showing regression or persistence of leakage. Moreover, alterations of the outer retinal layers can also be analyzed.
    01/2009;
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    ABSTRACT: To observe the tolerance of repeated intravitreous injections over the short and long term and to analyze their complications. The clinical records of consecutive patients having one or several intravitreous injections between 2002 and 2007 were evaluated, for all indications except the treatment of endophthalmitis. 2028 intravitreous injections were performed, mainly for age-related macular degeneration (n=1 192) or macular edema secondary to diabetes mellitus or retinal vein occlusion (n=41). The injected drug was triamcinolone acetonide 4 mg (339 injections), pegaptanib sodium 0.3 mg (1179 injections), and ranibizumab 0.3 (497 injections). The patients received 1-27 intravitreous injections per eye. The main complications were endophthalmitis (two after triamcinolone, 0.1% of the total group), pseudoendophthalmitis (two after triamcinolone, 0.1% of the total group), hypertony (7.69% of the total group, 13.78% after triamcinolone, 3.56% after pegaptanib, 1.21% after ranibizumab), including five cases of acute hypertony with transient light perception loss after ranibizumab, cataract (0.44% of total group), and macular hole (one patient after triamcinolone). No case of retinal detachment nor systemic complication was observed. Most of the complications were observed with the use of nonfiltered triamcinolone. The incidence of endophtalmitis was considerably lower with increased experience and the use of a dedicated room for the injections. Repeated injections were locally well tolerated. With the strict respect of asepsis rules, intravitreous injection seems well tolerated over the short and long term.
    Journal francais d'ophtalmologie 10/2008; 31(7):693-8. · 0.51 Impact Factor
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    ABSTRACT: Purpose Recent studies have highlighted the efficacy of Pegatanib sodium in sub-epithelial, occult, CNV seen in the early stages of the disease.Methods This was a prospective study with a follow-up of 24 months. Patients underwent a complete examination including ETDRS visual acuity measurements, fundus photographs, FA and ICG-A and OCT, as well as treatment by intra-vitreous injection every 6 weeks.Results 24 patients (16 women) presenting with exudative ARMD were chosen. The mean age was 76 years. 8 eyes had a sub-epithelial occult without classic neovascular lesion, or minimally classic. 8 eyes had a neovascular lesion of pre-epithelial type, predominantly classic. 4 eyes had a neovascular lesion of chorio-retinal anastomosis (CRA) associated with a PED. 4 lesions were fibro-vascular in type. At the end of the study, 100% of pure, occult type or « minimally classic » lesions presented with a loss of less than 15 letters of VA and in 25% of cases there was an improvement of 15 letters or more. Six out of eight treated patients did not lose any letter and five patients had an improvement of at least one letter. These patients had an initial VA of 20/100 or more. FA did not demonstrate any leakage in six cases, and OCT demonstrated an absence of intra-retinal edema in all cases. Out of the 16 patients who presented with a « predominantly classic » or with CRA or with fibro-vascular type lesion, only 3 had an improvement of at least one letter compared with 10 who had the loss of more than 15 letters of VA. Patients in younger age brackets had the better functional results.Conclusion Treatment with Pegaptanib sodium is indicated preferentially for occult or minimally classic type lesions, which are recent and small.
    Acta ophthalmologica 01/2008; 86:0-0. · 2.44 Impact Factor
  • Journal Francais D Ophtalmologie - J FR OPHTALMOL. 01/2008; 31:58-58.