- Email: [email protected]
070 Adaptation et évaluation de la version allemande de l’impact du profil de vidion et du questionnaire basse vision dans la DMLA atrophique géographique
Résultats: Two major parameters can be assessed using QoL instruments in ophthalmology and glaucoma: the instrument-specific visual-QoL and the patients´ vision-related utility. Whereas the first gives a good insight in patients´subjective impairment due to glaucoma and smaller changes in different dimensions can be detected, utility values can serve well for economic evaluations. There are a number of well-documented questionnaires to quantify the subjective impairment in glaucoma. The glaucoma-specific instruments have the greatest power of discrimination between glaucoma patients and control. The two major instruments for utility assessment are SG and TTO. Compared to the visual QoL assessed by the Visual Function Questionnaire 25 (VFQ-25) in a normal collective, patients with glaucoma have a clearly diminished QoL. Discussion: Visual QoL is strongly correlated with central vision, but also (less strongly) with the severity of visual field defects. The perfect QoL instrument for glaucoma has yet not been identified. The VFQ-25 appears to be the benchmark against which new glaucoma QoL instruments have to be compared. The Glaucoma Quality of Life 15 (GQL-15) is probably the most useful and clinically relevant tool. Utility instruments have the highest power for economic evaluations, whereas questionnaires have a better power to detect smaller changes in disease severity or progression. It is obvious, that current utility values in glaucoma differ markedly dependent on which method was used. Conclusion: Assessment of visual QoL is of increasing importance in patients with glaucoma. Individual assessment of patients´ impairment by the disease is an important factor in medical decision making for the clinician. QoL measurements allow to perform health economic analyses using utility values, which create wellfounded arguments in medical and health-policy decision making.
068 Qualité de vie : De la théorie à la pratique. Quality of Life: From theory to daily practice. NEUBAUER AS* (Munich, Allemagne)
Introduction: Quality of life (QoL) plays an increasingly important role in clinical studies and for the assessment of new technologies. It is directly relevant for evidence based individual patient treatment. Therefore the current study aims to summarize the impairment of vision-related QoL in selected diseases and their treatments. Materials and methods: A short review based on the methods of assessing quality of life is given. Focussing on important retinal diseases like age related macular degeneration, diabetic retinopathy and disorders of the vitreoretinal interface (macular holes, ERM) the impairment of vision-related QoL by the diseases and changes by treatment are illustrated. Implications for clinical practice are discussed and recommendations are given. Observation: While in some conditions visual acuity transfers well into visual QoL, this is frequently not the case and sometimes there is only weak or no correlation. Visual QoL is a more comprehensive endpoint including many other factors that influence vision such as visual field impairment, metamorphopsia or color perception. The visual QoL is also an expression of the visual preference of the individual patient. Discussion: As patient perceived quality of vision may be considered the real goal of ophthalmologic therapy, it should also be considered more systematically in daily practice. Visual quality of life has a different information value than visual acuity. Evidence based study results of large patient numbers can be applied to decide on the most suitable therapeutic regimen for the individual patient. Conclusion: Visual QoL has increasing importance not only in clinical studies but also in actual therapeutic decision making for the individual patient, although on many points further research is needed.
069 Différenciation immunohistochimique des tumeurs mélanocytaires des conjonctives. Immunohistochemical differentiation of melanocytic conjunctival tumors. GRENOT U.B.*, KAMPIK A, MESSMER EM .(Munich, Allemagne)
Introduction : La différenciation des lésions mélanocytaires des conjonctives peut être un véritable défi pour le clinicien ainsi que pour l´histopathologiste. Matériels et méthodes : Analyse immunohistochimique de 53 naevi conjonctivaux, 10 mélanoses primitives acquises sans atypies cytonucléaires, 25 mélanoses primitives acquises avec atypies et 24 mélanomes malins des conjonctives à l´aide de la méthode APAAP (phosphatase alcaline – phosphatase antialcaline). Des marqueurs des cellules mélanocytaires (PS100, HMB45, MelanA) ont été employés, ainsi que le marqueur de la prolifération cellulaire Ki-67. En outre, des marqueurs des lymphocytes T (anti-CD3) et des macrophages (anti-CD68) ont été utilisés, identifiant la présence d´une réaction inflammatoire associée. L´immunomarquage a été évalué selon l´intensité du marquage et la proportion des cellules marquées et en conséquence classé selon une échelle semi-quantitative allant de 0 à 3.
L´analyse statistique a été effectuée en utilisant le test exact de Fisher et le test de Mann-Whitney. Résultats : Il existait une différence significative des marquages PS100 (p = 0.027), HMB45 (p = 0.004), MelanA (p = 0.007), CD3 (p = 0.019) et CD68 (p = 0.015) entre les mélanoses primitives acquises sans atypies et les mélanoses primitives acquises avec atypies. On observait une augmentation significative de l’expression Ki 67 (p = 0.015) et de la proportion de lymphocytes T (p = 0.018) dans les mélanomes malins par rapport aux mélanoses primitives acquises avec atypies. Discussion : Les tumeurs des conjonctives bénignes, à potentiel malin et malignes peuvent être différenciés non seulement par des critères cytologiques, mais également par immunomarquage avec différents marqueurs mélanocytaires et inflammatoires. Conclusion : L’analyse immunohistochimique représente un moyen important, contribuant au diagnostic positif et différentiel de ces tumeurs, notamment dans le cas d’une histologie douteuse.
069 Bis Chimiothérapie directe intra-artérielle (artère ophtalmique) avec du malphalan dans le traiement conservateur du rétinoblastome intra-oculaire. Direct intraarterial (ophthalmic artery) chemotherapy with melphalan for intraocular retinoblastoma: a new conservative approach.
COMMUNICATIONS ORALES
Symposium Européen : Perspectives en ophtalmologieSymposium et qualité deEuropéen la vie par: Perspectives en ophtalmologie et qualité de la vie par l’innovation
HADJISTILIANOU D*, VENTURI C, DE FRANCESCO S, BRACCO S, BORRI M, DE LUCA MC (Sienne, Italie)
Objective: To avoid enucleation cannulating repeatedly the ophthalmic artery of young children with advanced retinoblastoma and giving melphalan that is tumoricidal for retinoblastoma when given intraarterially. Materials: 8 children with advanced retinoblastoma (Reese-Ellsworth stage V) eyes who were indicated for enucleation were entered in phase two of one center open study-approved protocol of ophthalmic artery infusion of melphalan to avoid enucleation. Methods: cannulation of the ophthalmic artery was performed by a femoral artery approach using microcatheters while the children were under anesthesia and anticoagulated. Chemotherapy (melphalan) was infused into the artery over a 30-minute period. Main outcome measures: ophthalmic examinations, retinal photography, and electroretinograms were used to document local toxicity, whereas physical examinations and complete blood counts were used to measure systemic toxicity. Results: the ophthalmic arteries were successfully cannulated in 6 cases (total, 11 times). Dramatic regression of relapses was obtained into 4 cases, and of vitreous and subretinal seeds was observed in two cases. No severe systemic side effects (sepsis, anemia, neutropenia, fever, or death) occurred. No transfusions were required (red cells or platelets). Three patients developed lid rush that resolved without treatment in two days. There was no toxicity to the cornea, anterior segment, pupil, or motility. Conclusions: we are experimenting a technique of direct ophthalmic artery infusion of melphalan for children with retinoblastoma. The technique has minimal systemic side effects and local toxicity. Therapeutic results in these 6 cases treated with this technique are reported and discussed.
070 Adaptation et évaluation de la version allemande de l’impact du profil de vidion et du questionnaire basse vision dans la DMLA atrophique géographique. Adaptation and evaluation of the German version of the impact of vision profile (IVI) and the low luminance questionnaire (LLQ) in Geographic Atrophy In Age-Related Macular Degeneration. FINGER RP* (Bonn, Allemagne), KLEINEMAS U (Bonn, Allemagne), LAMOUREAUX EL (Melbourne, Australie), OWSLEY C (Birmingham, Alabama, USA), SCHOLL HPN, HOLZ F.G. (Bonn, Allemagne)
Background: Patient-reported outcomes, such as visual function and quality of life, are met with increasing interest in the assessment of medical interventions. To offer a greater availability of valid psychometric tools in Germany, the German versions of the Impact of Vision Impairment Profile (IVI) and the Low Luminance Questionnaire (LLQ) were evaluated in a sample of patients with geographic atrophy (GA) due to advanced age-related macular degeneration (AMD). Methods: All questionnaires were translated, back translated and culturally adapted using feedback from patients. Subsequently, the 28-item IVI and 32-item LLQ were administered to 104 patients with GA due to AMD by telephone. Diagnosis had been confirmed within the FAM-study, which is a multi-centre natural history study of GA in Germany. All interviews were conducted by the same trained interviewer. The National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ25) was also administered in order to determine convergent validity of the IVI and 1S37
Vol. 32, Hors Série 1, 2009
115 e Congrès de la Société Française d'Ophtalmologie
Symposium Européen : Perspectives en ophtalmologie et qualité de la vie par Perspectives en ophtalmologie et qualité de la vie par l’innovation LLQ. The study adhered to the tenets of the Declaration of Helsinki and ethical approval had been obtained prior to the commencement of the study. Results: Mean ±SD age of patients was 78±6.7 yrs (40M, 64F), mean ±SD visual acuity of the better eye was LogMAR 0.4±0.29. Reliability was good for the overall score and subscales of the IVI (Cronbach’s alpha 0.82-0.83) and LLQ (Cronbach’s alpha 0.82-0.91), with a modest Cronbach’s alpha for the peripheral vision scale (0.42). Item-scale correlations ranged from 0.38-0.83 for the IVI and 0.48-0.93 for the LLQ. All scales of the IVI had fair to good correlations with matching subscales of the NEI-VFQ 25 (e.g. IVI scale emotional wellbeing to VFQ scale mental health; 0.48
070 Bis Cross-Linking : la méthode italienne. Cross-Linking: the Italian way. MAZZOTTA C*, BAIOCCHI S, CAPOROSSI A (Rome, Italie)
Purpose: Long term results of 163 keratoconic eyes treated in Italy by combined Riboflavin UV A collagen cross-linking in the open non randomized phase II clinical trial: “Siena Eye-Cross Study 2004”. Setting: 1Department Ophthalmology, Siena University, Italy. Methods: After local IRB approval, since September 2004 to September 2008, 163 eyes of 194 patients with progressive keratoconus were treated by Riboflavin UVA collagen Cross-Linking at Department of Ophthalmology of Siena University. In all cases, corneal epithelium was removed (blunt metal spatula) under topical anaesthesia (lidocaine 4% drops). The Riboflavin 0,1%-Dextrane 20 % sterile, disposable solution (Ricrolin, Sooft, Italy ®) was instilled every two minutes for 10 minutes of corneal soaking, then after the aiming beam assisted focus positioning, UV A irradiation of 3 mW/cm2 was by using the Caporossi, Baiocchi, Mazzotta Vega Xlinker C.S.O. for 6 steps of 5 minutes, in a 30 minutes total exposure. Treated eyes were medicated by antibiotics (ofloxacin drops) and dressed with a therapeutic soft contact lens for 4 days. All eyes were evaluated preoperatively and 1,3,6,12,18,24,36 and 48 months after surgery analyzing: UCVA, BSCVA, SSCVA, Endothelial cell count (I Conan, Non Con Robo V), Optical Pachometry (Visante OCT, Zeiss, Germany), US Pachometry (DGH Pachette), corneal topography (C.S.O., Italy) and tomography (Orbscan IIz, B&L), Surface aberrometry (C.S.O, Italy), posterior segment OCT (Stratus, Zeiss, Germany), in vivo confocal microscopy (HRT II, Rostock Cornea Module, Heidelberg, Germany). Results: No progression of keratoconus was detected in all treated eyes in the long term follow up of 48 months. The fellow control eyes showed a progression meanly of 1,5 D in over 45% in the first 12 months after the treatment and in over 65% in the longer time. The reduction of mean K value was meanly of 2 D and the early reduction of comatic aberration with corneal symmetry (SI) index improvement was observed in over 85% after 12 months continuing thereafter. After 48 months BSCVA improved meanly of 2.5 Snellen lines and UCVA of 2.3 Snellen lines, starting from third postoperative month to 48 months of follow up. Conclusion: Long term results of the Siena Eye Cross Study showed a clinical, topographical and wave-front improvements after CXL after 4 years of follow up without relevant side effects. According to our results, Riboflavin UV A corneal Cross-Linking maintain its stability after 4 years of evaluation. The recorded long term stability seems to be related to biochemical and micro-structural changes induced by photo-polymerization reaction and corneal collagen replacement. The better results were recorded in young Keratoconic patients under 26 years with progressive disease. The thinnest-point ≥ 400 microns and preoperative epithelial debridment are mandatory parameters in order to obtain an effective Cross-linking in a minimum depth of 250 microns.
1S38
115 e Congrès de la Société Française d'Ophtalmologie
J. Fr. Ophtalmol.
068 Qualité de vie : De la théorie à la pratique. Quality of Life: From theory to daily practice. NEUBAUER AS* (Munich, Allemagne)
Introduction: Quality of life (QoL) plays an increasingly important role in clinical studies and for the assessment of new technologies. It is directly relevant for evidence based individual patient treatment. Therefore the current study aims to summarize the impairment of vision-related QoL in selected diseases and their treatments. Materials and methods: A short review based on the methods of assessing quality of life is given. Focussing on important retinal diseases like age related macular degeneration, diabetic retinopathy and disorders of the vitreoretinal interface (macular holes, ERM) the impairment of vision-related QoL by the diseases and changes by treatment are illustrated. Implications for clinical practice are discussed and recommendations are given. Observation: While in some conditions visual acuity transfers well into visual QoL, this is frequently not the case and sometimes there is only weak or no correlation. Visual QoL is a more comprehensive endpoint including many other factors that influence vision such as visual field impairment, metamorphopsia or color perception. The visual QoL is also an expression of the visual preference of the individual patient. Discussion: As patient perceived quality of vision may be considered the real goal of ophthalmologic therapy, it should also be considered more systematically in daily practice. Visual quality of life has a different information value than visual acuity. Evidence based study results of large patient numbers can be applied to decide on the most suitable therapeutic regimen for the individual patient. Conclusion: Visual QoL has increasing importance not only in clinical studies but also in actual therapeutic decision making for the individual patient, although on many points further research is needed.
069 Différenciation immunohistochimique des tumeurs mélanocytaires des conjonctives. Immunohistochemical differentiation of melanocytic conjunctival tumors. GRENOT U.B.*, KAMPIK A, MESSMER EM .(Munich, Allemagne)
Introduction : La différenciation des lésions mélanocytaires des conjonctives peut être un véritable défi pour le clinicien ainsi que pour l´histopathologiste. Matériels et méthodes : Analyse immunohistochimique de 53 naevi conjonctivaux, 10 mélanoses primitives acquises sans atypies cytonucléaires, 25 mélanoses primitives acquises avec atypies et 24 mélanomes malins des conjonctives à l´aide de la méthode APAAP (phosphatase alcaline – phosphatase antialcaline). Des marqueurs des cellules mélanocytaires (PS100, HMB45, MelanA) ont été employés, ainsi que le marqueur de la prolifération cellulaire Ki-67. En outre, des marqueurs des lymphocytes T (anti-CD3) et des macrophages (anti-CD68) ont été utilisés, identifiant la présence d´une réaction inflammatoire associée. L´immunomarquage a été évalué selon l´intensité du marquage et la proportion des cellules marquées et en conséquence classé selon une échelle semi-quantitative allant de 0 à 3.
L´analyse statistique a été effectuée en utilisant le test exact de Fisher et le test de Mann-Whitney. Résultats : Il existait une différence significative des marquages PS100 (p = 0.027), HMB45 (p = 0.004), MelanA (p = 0.007), CD3 (p = 0.019) et CD68 (p = 0.015) entre les mélanoses primitives acquises sans atypies et les mélanoses primitives acquises avec atypies. On observait une augmentation significative de l’expression Ki 67 (p = 0.015) et de la proportion de lymphocytes T (p = 0.018) dans les mélanomes malins par rapport aux mélanoses primitives acquises avec atypies. Discussion : Les tumeurs des conjonctives bénignes, à potentiel malin et malignes peuvent être différenciés non seulement par des critères cytologiques, mais également par immunomarquage avec différents marqueurs mélanocytaires et inflammatoires. Conclusion : L’analyse immunohistochimique représente un moyen important, contribuant au diagnostic positif et différentiel de ces tumeurs, notamment dans le cas d’une histologie douteuse.
069 Bis Chimiothérapie directe intra-artérielle (artère ophtalmique) avec du malphalan dans le traiement conservateur du rétinoblastome intra-oculaire. Direct intraarterial (ophthalmic artery) chemotherapy with melphalan for intraocular retinoblastoma: a new conservative approach.
COMMUNICATIONS ORALES
Symposium Européen : Perspectives en ophtalmologieSymposium et qualité deEuropéen la vie par: Perspectives en ophtalmologie et qualité de la vie par l’innovation
HADJISTILIANOU D*, VENTURI C, DE FRANCESCO S, BRACCO S, BORRI M, DE LUCA MC (Sienne, Italie)
Objective: To avoid enucleation cannulating repeatedly the ophthalmic artery of young children with advanced retinoblastoma and giving melphalan that is tumoricidal for retinoblastoma when given intraarterially. Materials: 8 children with advanced retinoblastoma (Reese-Ellsworth stage V) eyes who were indicated for enucleation were entered in phase two of one center open study-approved protocol of ophthalmic artery infusion of melphalan to avoid enucleation. Methods: cannulation of the ophthalmic artery was performed by a femoral artery approach using microcatheters while the children were under anesthesia and anticoagulated. Chemotherapy (melphalan) was infused into the artery over a 30-minute period. Main outcome measures: ophthalmic examinations, retinal photography, and electroretinograms were used to document local toxicity, whereas physical examinations and complete blood counts were used to measure systemic toxicity. Results: the ophthalmic arteries were successfully cannulated in 6 cases (total, 11 times). Dramatic regression of relapses was obtained into 4 cases, and of vitreous and subretinal seeds was observed in two cases. No severe systemic side effects (sepsis, anemia, neutropenia, fever, or death) occurred. No transfusions were required (red cells or platelets). Three patients developed lid rush that resolved without treatment in two days. There was no toxicity to the cornea, anterior segment, pupil, or motility. Conclusions: we are experimenting a technique of direct ophthalmic artery infusion of melphalan for children with retinoblastoma. The technique has minimal systemic side effects and local toxicity. Therapeutic results in these 6 cases treated with this technique are reported and discussed.
070 Adaptation et évaluation de la version allemande de l’impact du profil de vidion et du questionnaire basse vision dans la DMLA atrophique géographique. Adaptation and evaluation of the German version of the impact of vision profile (IVI) and the low luminance questionnaire (LLQ) in Geographic Atrophy In Age-Related Macular Degeneration. FINGER RP* (Bonn, Allemagne), KLEINEMAS U (Bonn, Allemagne), LAMOUREAUX EL (Melbourne, Australie), OWSLEY C (Birmingham, Alabama, USA), SCHOLL HPN, HOLZ F.G. (Bonn, Allemagne)
Background: Patient-reported outcomes, such as visual function and quality of life, are met with increasing interest in the assessment of medical interventions. To offer a greater availability of valid psychometric tools in Germany, the German versions of the Impact of Vision Impairment Profile (IVI) and the Low Luminance Questionnaire (LLQ) were evaluated in a sample of patients with geographic atrophy (GA) due to advanced age-related macular degeneration (AMD). Methods: All questionnaires were translated, back translated and culturally adapted using feedback from patients. Subsequently, the 28-item IVI and 32-item LLQ were administered to 104 patients with GA due to AMD by telephone. Diagnosis had been confirmed within the FAM-study, which is a multi-centre natural history study of GA in Germany. All interviews were conducted by the same trained interviewer. The National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ25) was also administered in order to determine convergent validity of the IVI and 1S37
Vol. 32, Hors Série 1, 2009
115 e Congrès de la Société Française d'Ophtalmologie
Symposium Européen : Perspectives en ophtalmologie et qualité de la vie par Perspectives en ophtalmologie et qualité de la vie par l’innovation LLQ. The study adhered to the tenets of the Declaration of Helsinki and ethical approval had been obtained prior to the commencement of the study. Results: Mean ±SD age of patients was 78±6.7 yrs (40M, 64F), mean ±SD visual acuity of the better eye was LogMAR 0.4±0.29. Reliability was good for the overall score and subscales of the IVI (Cronbach’s alpha 0.82-0.83) and LLQ (Cronbach’s alpha 0.82-0.91), with a modest Cronbach’s alpha for the peripheral vision scale (0.42). Item-scale correlations ranged from 0.38-0.83 for the IVI and 0.48-0.93 for the LLQ. All scales of the IVI had fair to good correlations with matching subscales of the NEI-VFQ 25 (e.g. IVI scale emotional wellbeing to VFQ scale mental health; 0.48
070 Bis Cross-Linking : la méthode italienne. Cross-Linking: the Italian way. MAZZOTTA C*, BAIOCCHI S, CAPOROSSI A (Rome, Italie)
Purpose: Long term results of 163 keratoconic eyes treated in Italy by combined Riboflavin UV A collagen cross-linking in the open non randomized phase II clinical trial: “Siena Eye-Cross Study 2004”. Setting: 1Department Ophthalmology, Siena University, Italy. Methods: After local IRB approval, since September 2004 to September 2008, 163 eyes of 194 patients with progressive keratoconus were treated by Riboflavin UVA collagen Cross-Linking at Department of Ophthalmology of Siena University. In all cases, corneal epithelium was removed (blunt metal spatula) under topical anaesthesia (lidocaine 4% drops). The Riboflavin 0,1%-Dextrane 20 % sterile, disposable solution (Ricrolin, Sooft, Italy ®) was instilled every two minutes for 10 minutes of corneal soaking, then after the aiming beam assisted focus positioning, UV A irradiation of 3 mW/cm2 was by using the Caporossi, Baiocchi, Mazzotta Vega Xlinker C.S.O. for 6 steps of 5 minutes, in a 30 minutes total exposure. Treated eyes were medicated by antibiotics (ofloxacin drops) and dressed with a therapeutic soft contact lens for 4 days. All eyes were evaluated preoperatively and 1,3,6,12,18,24,36 and 48 months after surgery analyzing: UCVA, BSCVA, SSCVA, Endothelial cell count (I Conan, Non Con Robo V), Optical Pachometry (Visante OCT, Zeiss, Germany), US Pachometry (DGH Pachette), corneal topography (C.S.O., Italy) and tomography (Orbscan IIz, B&L), Surface aberrometry (C.S.O, Italy), posterior segment OCT (Stratus, Zeiss, Germany), in vivo confocal microscopy (HRT II, Rostock Cornea Module, Heidelberg, Germany). Results: No progression of keratoconus was detected in all treated eyes in the long term follow up of 48 months. The fellow control eyes showed a progression meanly of 1,5 D in over 45% in the first 12 months after the treatment and in over 65% in the longer time. The reduction of mean K value was meanly of 2 D and the early reduction of comatic aberration with corneal symmetry (SI) index improvement was observed in over 85% after 12 months continuing thereafter. After 48 months BSCVA improved meanly of 2.5 Snellen lines and UCVA of 2.3 Snellen lines, starting from third postoperative month to 48 months of follow up. Conclusion: Long term results of the Siena Eye Cross Study showed a clinical, topographical and wave-front improvements after CXL after 4 years of follow up without relevant side effects. According to our results, Riboflavin UV A corneal Cross-Linking maintain its stability after 4 years of evaluation. The recorded long term stability seems to be related to biochemical and micro-structural changes induced by photo-polymerization reaction and corneal collagen replacement. The better results were recorded in young Keratoconic patients under 26 years with progressive disease. The thinnest-point ≥ 400 microns and preoperative epithelial debridment are mandatory parameters in order to obtain an effective Cross-linking in a minimum depth of 250 microns.
1S38
115 e Congrès de la Société Française d'Ophtalmologie
J. Fr. Ophtalmol.