Un patient âge de 56 ans, diabetique, est adresse pour realisation d'un fond d'oeil de de... more Un patient âge de 56 ans, diabetique, est adresse pour realisation d'un fond d'oeil de depistage. Il presente un diabete de type 2 evoluant depuis 20 ans devenu insulino-requerant 6 ans apres le diagnostic. Il n'a jamais ete examine par un ophtalmologiste.
DME is the main cause of loss of vision over the course of diabetes. DME incidence is correlated ... more DME is the main cause of loss of vision over the course of diabetes. DME incidence is correlated with diabetes duration, high glycemic levels, high blood pressure, and the severity of diabetic retinopathy. To prevent DME, patients need to have access to medical care. In this study, we sought to know whether DME was more severe in Seine-Saint-Denis, a French area, where the poverty is higher than in other french places, and where the number of physicians is lower. We enrolled patients suffering from DME and treated by ranibizumab intravitreal injections between November 2012 and April 2013. In order to evaluate the severity of DME and the medical management of diabetes of these patients, we collected the following parameters: central macular thickness measured by SD-OCT, best corrected visual acuity, diabetic retinopathy severity, HbA1c, diabetes duration, type of diabetes, insulinotherapy, previous DME treatment and associated diseases. We included 25 type 2 diabetic patients (8 women and 17 men), the mean age was 64±8.1 years. Mean central macular thickness was 523±145μm. The best corrected visual acuity was 45 letters at baseline (counting fingers-70 letters). Twenty-two patients (88%) had a severe non-proliferative diabetic retinopathy or a proliferative diabetic retinopathy. Mean HbA1c was 7.8% (±2.3%). For 23 cases (92%), diabetes was associated with high blood pressure. Sixty-four percent were treated by insulin. Diabetes lasted for 13.1 years at baseline. Diabetic patients, in this case series, had a more severe DME regarding macular thickness and visual acuity than patients from large randomized studies found in the literature. This severity could be due to a sub-optimal management of their diabetes. DME may become a tool to identify patients with a limited access to good medical cares.
To evaluate the effect of trimetazidine (TMZ) in a randomized, double-blind, placebo-controlled c... more To evaluate the effect of trimetazidine (TMZ) in a randomized, double-blind, placebo-controlled clinical trial on the occurrence of choroidal neovascularization or geographic atrophy in age-related macular degeneration. A total of 1,086 patients from France, Belgium, and Spain with soft drusen and/or retinal pigment epithelium abnormalities in the study eye and choroidal neovascularization in the contralateral eye were randomly assigned to receive orally placebo or TMZ 70 mg daily (35 mg × 2) and followed-up for 3 years to 5 years. Treatment duration ranged between 0.4 months and 67.8 months with a mean ± SD of 38 ± 16 months. Three hundred and fifty-eight patients developed choroidal neovascularization (incidence per 100 patient-years: TMZ 10.86; placebo 11.13). Trimetazidine did not prevent the choroidal neovascularization (hazard ratio = 0.97; 95% confidence interval, 0.77-1.20; P = 0.781). However, there was a trend favoring TMZ for retinal atrophy, a secondary endpoint (HR = 0.76; 95% confidence interval, 0.56-1.02; P = 0.069). Overall, the difference in atrophy incidence between TMZ and placebo was not statistically different. Differences within some prespecified subgroups of patients showed superiority of TMZ in men (HR = 0.50; 95% confidence interval, 0.28-0.89; p = 0.016), in patients aged ≤75 years (HR = 0.58; 95% confidence interval, 0.38-0.88; p = 0.010), or in patients presenting with isolated pigmentary changes (HR = 0.19; 95% confidence interval, 0.05-0.70; p = 0.005). Trimetazidine failed to prevent choroidal neovascularization. Subgroup analyses suggest that this drug could be tested as preventive therapy for geographic atrophy, although the overall comparison showed no statistically significant differences in the progression of geographic atrophy.
Takayasu arteritis is a nonspecific granulomatous inflammatory arteriopathy of unknown cause, mos... more Takayasu arteritis is a nonspecific granulomatous inflammatory arteriopathy of unknown cause, most frequently diagnosed in young Asian women. The authors present an atypical initial presentation of Takayasu disease with bilateral loss of vision in a young Haitian man. Case report. The presenting feature was bilateral loss of vision, a result of malignant hypertensive retinopathy and choroidopathy. Systemic evaluation disclosed inflammatory signs and renal artery obstruction which caused the malignant hypertension. This case, involving an unusual presentation of Takayasu disease, illustrates how a malignant hypertensive retinopathy and choroidopathy led to the ultimate diagnosis of Takayasu disease.
Un patient âge de 56 ans, diabetique, est adresse pour realisation d'un fond d'oeil de de... more Un patient âge de 56 ans, diabetique, est adresse pour realisation d'un fond d'oeil de depistage. Il presente un diabete de type 2 evoluant depuis 20 ans devenu insulino-requerant 6 ans apres le diagnostic. Il n'a jamais ete examine par un ophtalmologiste.
DME is the main cause of loss of vision over the course of diabetes. DME incidence is correlated ... more DME is the main cause of loss of vision over the course of diabetes. DME incidence is correlated with diabetes duration, high glycemic levels, high blood pressure, and the severity of diabetic retinopathy. To prevent DME, patients need to have access to medical care. In this study, we sought to know whether DME was more severe in Seine-Saint-Denis, a French area, where the poverty is higher than in other french places, and where the number of physicians is lower. We enrolled patients suffering from DME and treated by ranibizumab intravitreal injections between November 2012 and April 2013. In order to evaluate the severity of DME and the medical management of diabetes of these patients, we collected the following parameters: central macular thickness measured by SD-OCT, best corrected visual acuity, diabetic retinopathy severity, HbA1c, diabetes duration, type of diabetes, insulinotherapy, previous DME treatment and associated diseases. We included 25 type 2 diabetic patients (8 women and 17 men), the mean age was 64±8.1 years. Mean central macular thickness was 523±145μm. The best corrected visual acuity was 45 letters at baseline (counting fingers-70 letters). Twenty-two patients (88%) had a severe non-proliferative diabetic retinopathy or a proliferative diabetic retinopathy. Mean HbA1c was 7.8% (±2.3%). For 23 cases (92%), diabetes was associated with high blood pressure. Sixty-four percent were treated by insulin. Diabetes lasted for 13.1 years at baseline. Diabetic patients, in this case series, had a more severe DME regarding macular thickness and visual acuity than patients from large randomized studies found in the literature. This severity could be due to a sub-optimal management of their diabetes. DME may become a tool to identify patients with a limited access to good medical cares.
To evaluate the effect of trimetazidine (TMZ) in a randomized, double-blind, placebo-controlled c... more To evaluate the effect of trimetazidine (TMZ) in a randomized, double-blind, placebo-controlled clinical trial on the occurrence of choroidal neovascularization or geographic atrophy in age-related macular degeneration. A total of 1,086 patients from France, Belgium, and Spain with soft drusen and/or retinal pigment epithelium abnormalities in the study eye and choroidal neovascularization in the contralateral eye were randomly assigned to receive orally placebo or TMZ 70 mg daily (35 mg × 2) and followed-up for 3 years to 5 years. Treatment duration ranged between 0.4 months and 67.8 months with a mean ± SD of 38 ± 16 months. Three hundred and fifty-eight patients developed choroidal neovascularization (incidence per 100 patient-years: TMZ 10.86; placebo 11.13). Trimetazidine did not prevent the choroidal neovascularization (hazard ratio = 0.97; 95% confidence interval, 0.77-1.20; P = 0.781). However, there was a trend favoring TMZ for retinal atrophy, a secondary endpoint (HR = 0.76; 95% confidence interval, 0.56-1.02; P = 0.069). Overall, the difference in atrophy incidence between TMZ and placebo was not statistically different. Differences within some prespecified subgroups of patients showed superiority of TMZ in men (HR = 0.50; 95% confidence interval, 0.28-0.89; p = 0.016), in patients aged ≤75 years (HR = 0.58; 95% confidence interval, 0.38-0.88; p = 0.010), or in patients presenting with isolated pigmentary changes (HR = 0.19; 95% confidence interval, 0.05-0.70; p = 0.005). Trimetazidine failed to prevent choroidal neovascularization. Subgroup analyses suggest that this drug could be tested as preventive therapy for geographic atrophy, although the overall comparison showed no statistically significant differences in the progression of geographic atrophy.
Takayasu arteritis is a nonspecific granulomatous inflammatory arteriopathy of unknown cause, mos... more Takayasu arteritis is a nonspecific granulomatous inflammatory arteriopathy of unknown cause, most frequently diagnosed in young Asian women. The authors present an atypical initial presentation of Takayasu disease with bilateral loss of vision in a young Haitian man. Case report. The presenting feature was bilateral loss of vision, a result of malignant hypertensive retinopathy and choroidopathy. Systemic evaluation disclosed inflammatory signs and renal artery obstruction which caused the malignant hypertension. This case, involving an unusual presentation of Takayasu disease, illustrates how a malignant hypertensive retinopathy and choroidopathy led to the ultimate diagnosis of Takayasu disease.
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Papers by Gilles Chaine