BackgroundTo report the results of multimodal imaging of a biochemically confirmed case of a family with gyrate atrophy (GA) associated with foveoschisis and macular pseudohole.Case presentationTwo sisters presented to us with progressive bilateral decreased vision. The 26-year old sister had a best corrected visual acuity (BCVA) of 20/32 in the right eye (RE) and 20/100 in the left eye (LE). Dilated fundus examination revealed multiple bilateral chorioretinal atrophy areas in the midperipheral and peripheral retina. Fluorescein angiography did not show any leak in the macular area. Swept-source optical coherence tomography (SS-OCT) showed increased central macular thickness in both eyes with foveoschisis. Optical coherence tomography angiography (OCTA) showed petaloid non-reflective areas and some perifoveal microvascular alterations similar to telangiectasias in the deep capillary complex. The 30-year-old sister had a BCVA of 20/20 in the RE and 20/32 in the LE. SS-OCT was normal in the RE and demonstrated a macular pseudohole with a fine epiretinal membrane in the LE. The persistent retinal tissue at the base of the pseudohole was disorganised. Blood tests showed hyperornithinemia in the 2 cases. Based on these observations, the patients were diagnosed with gyrate atrophy of the choroid and retina and were treated with a pyridoxine supplement and an arginine-restricted diet.ConclusionsFoveoschisis and macular pseudohole may be associated in GA, increasing the risk of rapid vision loss. OCTA is an interesting imaging tool that can help to better understand the pathophysiological mechanism of these macular involvements in GA.

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PurposeIn March 2020, the sudden rise in number of SARS-CoV2 infections in France let the government to impose a strict lockdown during which all non-urgent medical consultations were postponed. From March 17 to May 10, 2020, private medical practices were closed and telemedicine was encouraged. The consequences on ophthalmic care were dramatic with over 90% of scheduled consultations canceled. The aim of this study was to report the consultation during the 2-month strict lockdown in Paris and to analyze its impact on the visual outcomes of patients consulting in the ophthalmology emergency department (OED) Methods :Data of patients who presented to the OED of the A. de Rothschild Foundation Hospital (RFH), a tertiary ophthalmology center in Paris, France, during the lockdown period and its immediate aftermath were analyzed. The results were compared to the same time periods in the years of 2018 and 2019. Four time periods were defined and numbered chronologically: March 17 to May 10, 2018 (Period 1) ; March 17 to May 10, 2019 (Period 2); March 17 to May 10, 2020 (Period 3, the lockdown period); May 11 to June 9, 2020 (Period 4, the post-lockdown period)Results :The number of consultation was reduced by more than 50% during the lockdown period (n=2909 patients) and by 30% during the post-lockdown period (n=2622) when compared to periods 1 (n=7125) and 2 (n=8058) Even though LP4 saw an increase in the number of consulting patients, there was no raise in the rate of severe diseases (12.8% during LP3 vs 11.1% during LP4) and the proportion of patients who were padmitted was statistically similar (4.3% VS 3.6%). Neuro-ophthalmic -diseases were the most common during LP3 and LP4. Neovascular glaucoma were twice as common during post LP4 (p=0.08). We highlighted a significant increase in patients with a graft reject consulting in our OED during the post LP4 (p<0.001). Those results were likely related to a delay in the follow-up consultations due to the lockdown measures.ConclusionThe reduction in the number of consultations in our OED during the lockdown period did not focus mainly on minor emergencies and also affected severe ophthalmic diseases with no significant delay in consultation. More longitudinal and longer study is needed to confirm this and to analyze retrospectively the COVID-19 outbreak and lockdown effects.

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