Fondation de Rothschild

We present a reproducible, stepwise middle fossa approach for facial nerve decompression focused on the labyrinthine segment, geniculate ganglion, and meatal foramen, with consistent anatomical landmarks to preserve hearing. The article and video detail patient setup, safe corridor creation, and retrograde drilling with practical tips to avoid cochlear or semicircular canal injury, aiming to lower the learning curve for facial nerve decompression.

To evaluate whether baseline glycosylate hemoglobin (HbA1C) levels play a predictive role in faricimab loading phase outcomes. Additionally, we assessed the efficacy of faricimab loading phase for diabetic macular edema (DME). We conducted a retrospective, multicentric, interventional cohort study including 74 eyes, presenting with a central macular thickness (CMT) > 280 µm, visual acuity (VA) > 20/200, and OCT-based diagnosis of DME. A statistically significant negative correlation was found between baseline HbA1c and the change in VAfollowing intravitreal faricimab injections (ρ = -0.32, p = 0.006) ). In multivariable regression thisassociation was not significant (β ≈ -0.026 logMAR per 1% HbA1c; p=0.26; ≈ +1.3 letters/1%). The correlation between baseline HbA1c and the change in CMT wasnot statistically significant (ρ = +0.13, p = 0.279). VA improved significantly from baseline to post-treatment ((-0.18± 0.22 Δ LogMAR ;p < 0.0001). Mean baseline CMT (440.4 ± 152.9 micron) significantly decreased (310.9 ± 87.8 micron, p < 0.0001). We observed a significant reduction of hyperreflective foci(p < 0.0001) and intraretinal fluid (IRF) (p = 0.0014), and the subretinal fluid (SRF) decreased from 29.7% to 10.8% after treatment (p = 0.023). Systemic glycemic status may influence functional outcomes, supporting the importance of maintaining optimal HbA1c levels in the overall management of diabetic patients. However, baseline HbA1c did not emerge as an independent predictor in this cohort. Notably, Faricimab provided clear anatomical and functional benefits regardless of glycemic control, confirming its efficacy as a treatment for DME.

This study investigated the impact of scan orientation on the detection of chorioretinal folds using spectral-domain optical coherence tomography (SD-OCT). A total of 64 eyes with chorioretinal folds were included. The ability to identify folds was compared between horizontal and vertical B-scan acquisitions. Two independent observers evaluated the SD-OCT scans to determine the visibility of folds. Vertical scan orientation revealed folds in 63 of 64 cases (98.4%), whereas horizontal scans identified folds in only 26 cases (40.6%). Our findings show that chorioretinal folds were more consistently and clearly identified in vertically oriented scans than in horizontal scans, suggesting that scan direction significantly influences the detection and evaluation of these lesions.

Introduction: Intracranial stenting during endovascular thrombectomy (EVT) is a common practice in the setting of failed reperfusion or severe stenosis. Immediate stent patency requires periprocedural antiplatelet therapy (APT). How APT intensity interacts with prior intravenous thrombolysis (IVT) to influence hemorrhagic risk remains uncertain. We aimed to assess whether the APT regimen modifies the association of IVT with early intracranial hemorrhage after intracranial stenting during EVT. Methods: This was a subanalysis of the RESISTANT registry, a multicenter, international, retrospective cohort (2016 to 2023) of adults with acute ischemic stroke who underwent intracranial stenting during EVT. APT regimens were categorized as conservative (intravenous or oral aspirin alone, or aspirin plus an oral P2Y12 inhibitor) and aggressive (any regimen including intravenous GPIIb/IIIa inhibitor or intravenous cangrelor). Four main groups were compared according to the APT regimen (conservative/aggressive) and the use of IVT (+/-). The primary outcome was a composite of sICH and parenchymal hematoma types 1 and 2 (sICH-PH2-PH1). Multivariable logistic regression models were used to evaluate the interaction between IVT and APT, adjusting for clinically relevant covariates. Results: Among the 823 included patients, 44 (5.3%) received conservative APT with IVT, 130 (15.8%) received conservative APT without IVT, 145 (17.6%) received aggressive APT with IVT, and 504 (61.2%) received aggressive APT without IVT. Among patients who received IVT, sICH-PH2-PH1 rates were 9.3% with conservative APT and 10.7% with aggressive APT; among those without IVT, rates were 3.2% and 9.9%, respectively. Administration of IVT (adjusted odds ratio [aOR] 5.84, 95%CI 1.07 to 43.92; p=0.05) and aggressive APT (aOR 4.81, 95% CI 1.41 to 30.22; p=0.03) were each associated with higher odds of hemorrhagic complications, with a significant IVT by APT interaction (P interaction =0.05; Figures 1 and 2 ). Within the aggressive APT plus IVT subgroup, sICH-PH2-PH1 occurred in 20% of patients treated with cangrelor and 6.1% treated with a glycoprotein IIb/IIIa inhibitor ( Figure 3 ). Conclusion: Among patients requiring intracranial stenting, aggressive periprocedural APT and prior IVT are each associated with higher hemorrhagic risk, with the combination showing the worst observed crude outcome. Prospective evaluation of protocolized APT pathways in the IVT setting is warranted.

Rod photoreceptors are essential for vision under dim light conditions and are highly vulnerable in retinal degenerative diseases. Here, we demonstrate that both human and rodent rods undergo a minute and rapid contraction of their outer segments upon photoisomerization, the first step of phototransduction. The contraction is explained as an electromechanical manifestation of the rod early receptor potential generated in the disk membranes, which is challenging to access in electrophysiology. The in vivo optical imaging of light-evoked electrical activity in rodent rods was facilitated by an ultrahigh-resolution point-scan optical coherence tomography (OCT) system, combined with an unsupervised learning approach to separate the light-evoked response of the rod outer segment tips from the retinal pigment epithelium-Bruch’s membrane complex. In humans, an adaptive optics line-scan OCT facilitated high-speed recordings in rods. The non-invasive in vivo optical imaging of rhodopsin activation extends the diagnostic capability of optoretinography, and may facilitate personalized, objective assessment of rod dysfunction and visual cycle impairment in inherited and age-related macular degeneration.

Children born preterm often have anatomical and functional visual abnormalities, even in the absence of retinopathy of prematurity. This includes suboptimal visual acuity (VA), defined as binocular VA between 5-6.3/10 and 8/10. We examine relationships between suboptimal VA and neurodevelopment in children born preterm. Secondary analysis of the French EPIPAGE-2 cohort with children born between 24+0 weeks and 31+6 weeks of gestation, eligible for follow-up at 5.5 years. Children were classified into three VA groups: 5-6.3/10, 8/10 and 10/10 as reference group. Neurodevelopment was assessed with the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition, the Movement Assessment Battery for Children-II (MABC-2) and the Strengths and Difficulties Questionnaire (SDQ). Comparisons between groups were adjusted for neonatal and socioeconomic characteristics using generalised estimating equations models. Among 1787 included children, 62% had suboptimal VA. Compared with the 10/10 VA group, the mean full-scale IQ decreased by -3.09 (95 % CI -4.75 to -1.42) and -4.97 (95 % CI -6.47 to -3.46) points, the mean MABC-2 total score by -0.66 (95 % CI -0.71 to -0.61) and -1.06 (95 % CI -1.09 to -1.00), and the mean total SDQ scores increased by 0.40 (95 % CI -0.16 to 0.94) and 0.60 (95 % CI 0.10 to 1.1) in groups with VA groups at 8/10 and 5-6.3/10, respectively. In this French population-based cohort of children born preterm, suboptimal VA was frequent and associated with increased risk of neurodevelopmental difficulties. A comprehensive neurodevelopmental and neurovisual assessment is warranted in children born preterm with suboptimal VA.