Evaluation of a topical cyclosporine A prodrug on corneal graft rejection in rats.

PURPOSE: To assess the efficacy of a topical cyclosporine A (CsA), water-soluble prodrug, for promoting the survival of allogenic rat corneal grafts after penetrating keratoplasty (PKP). METHODS: Corneas of Brown-Norway rats (donors) were transplanted to Lewis rats (recipients). Transplanted rats were divided in three treatment groups: group I (PBS) and group II (0.26% Debio088) received drops five times per day. Group III received a daily intramuscular CsA injection (10 mg/kg/day). Blood CsA concentrations were measured on days 2 and 14. On day 4, 10, 13 after PKP, grafts were scored for corneal transparency, edema and extent of neovascularization. An opacity score of greater than or equal to 3 was considered as a nonreversible graft rejection process. On day 14, the experimental eyes were processed for histology. RESULTS: On day 13, 12 of the 18 corneal transplants (67%) in group I showed irreversible graft rejection. Three of 18 transplants (19%) in group II and 5 of 16 transplants (28%) in group III showed irreversible graft rejection (p=0.013/p=0.019, OR=0.14/0.06 versus vehicle). Each mean clinical score for edema, opacity, and neovessels in group II were significantly lower than those of the grafts in group I (respectively p=0.010, p=0.013, p=0.024) and III except for neovessels (respectively p=0.002, p=0.001, p=0.057). Histology confirmed the clinical results. The mean CsA blood levels for groups II and III were, respectively 54+/-141 mug/l and 755+/-319 mug/l on day 2 and 14+/-34 mug/l and 1318+/-463 mug/l on day 14. CONCLUSIONS: Debio088 CsA prodrug drops given five times daily are as effective as intramuscular injection of 10 mg/kg/day for the prevention of acute corneal graft rejection in rats.

[What do we know about intraocular pressure in the Togolese population?]. / Que savons-nous de la pression intra-oculaire dans la population togolaise?

BACKGROUND: Intraocular pressure is a major ocular risk factor of chronic open angle glaucoma. This study aimed to describe characteristics of intraocular pressure in a defined black African population. METHODS: Hospital outpatients were recruited for this study, and all measures were taken with a pulse air tonometer between 8 AM and 12 AM; some participants were glaucoma patients under medical treatment. On the whole, 7,042 participants (13,831 eyes) were included in this study. RESULTS: The mean age of all participants was 41 +/- 18 years: 9.9% were under 16 years of age; 21.2% were between 35 and 44 years old. The average intraocular pressure was 17.05+/-5.93 mmHg; for the subgroup under 16 years of age. Girls had higher pressure than boys: 16.01 vs 16.32 mmHg in the right eye. For those over 16 years of age, pressures were higher in men, with an average of 17.45 mmHg vs 16.67 mmHg in the right eye. High intraocular pressure was found in 22.28% of the participants, with values ranging from 20 to 29 mmHg in 86.8% of cases. The relative prevalence of hypertony seems to increase with age, reaching 30% for those aged 55-64 years. CONCLUSION: There is a high rate of hypertony in our findings, which seems to correlate with the increased glaucoma prevalence already described in the Togolese population. We concluded that in our setting, the prevention of glaucoma in isolated hypertonies and the management of glaucomatous cases warrant a thorough assessment of intraocular pressure at all ages.

[Familial primary pulmonary hypertension revealed by the association of bilateral chemosis, subacute myopia, and exophthalmos]. / Hypertension artérielle pulmonaire primitive familiale révélée par l'association bilatérale chémosis, myopisation et exophtalmie.

PURPOSE: To report a rare case of primary pulmonary hypertension (PPH) revealed by a relapsing chemosis, exophthalmos, and subacute myopia. PATIENTS AND METHODS: A 46-year-old woman presented with recurrent bouts of chemosis, exophthalmos, and subacute myopia. Her visual troubles were triggered by physical effort. She had a history of a longstanding high blood pressure that was noncompliant to all conventional hypotensive therapy. Automated refraction under cycloplegia showed recent myopia. At observation she had a bilateral, moderate chemosis. Hertel exophthalmometer measured a symmetric exophthalmos of 23 mm. Intraocular pressure was 20 mmHg OD and 24 mmHg OS. Eye fundus was strictly normal. RESULTS: Laboratory analysis showed no thyroid or inflammatory disease. HIV serology was negative as were antinuclear antibodies. Orbital CT confirmed the axial, symmetric exophthalmos. Echocardiogram brought out the diagnosis of PPH. Genetic studies by PCR localized the BMPR2 mutation that is characteristic of the familial type of PPH. Symptoms decreased under treatment. DISCUSSION: PPH is a rare disease caused by thickening of the arteriolar walls in the pulmonary bed, which results in a right-heart hypertension with venous stasis. Many authors have reported different posterior segment diseases secondary to PPH. However, anterior segment manifestations are extremely rare. These may be caused by a ciliary body congestion and retrobulbar vasodilatation. CONCLUSION: The association of chemosis, exophthalmos, and subacute myopia is unusual in PPH. We recommend keeping in mind the PPH as a differential diagnosis in those cases, especially in patients who suffer from high blood pressure.

[Acanthamoeba stromal keratitis: epidemiology and prognosis factors]. / Kératites stromales amibiennes: épidémiologie et facteurs pronostiques.

PURPOSE: Early treatment of amebic stromal keratitis can change patients' final visual and esthetic prognosis. The aim of this study was to review all proven Acanthamoeba stromal keratitis cases presenting at our ophthalmology emergency department over the past 3 years, in order to delineate the incidence and the factors still leading to this serious complication. PATIENTS: and methods: All cases of Acanthamoeba stromal keratitis confirmed with a parasitology examination and treated between January 2000 and December 2002 were recorded. During this period of time, eight patients were identified with this condition. Their charts, as well as biomicroscopic, therapeutic, and outcome data were analyzed. RESULTS: All patients were referred in a second or third intention. Only one patient did not usually wear contact lenses. Six patients had an associated bacterial abscess. The typical amebic annular infiltrate was only observed in one patient. Three patients received an effective antiamebic treatment in the 15 days following the first symptoms and five patients 1 month or more after. An emergency keratoplasty was carried out in one patient. Finally, visual acuity was lower than 5/10 in all cases. The patients treated in the first 15 days had the best final visual acuity. DISCUSSION: Soft contact lenses are still responsible for the majority of serious amebic corneal complications. Late diagnosis remains the main cause of Acanthamoeba stromal keratitis development, particularly in the absence of contact lens history, because of the delay in treatment. CONCLUSION: The catastrophic consequences of this complication justify a systematic treatment against ameba in each case of suspected diagnosis. An early and effective treatment of the stromal amebic keratitis can increase the final visual prognosis.

[Glaucoma characteristics in 13 families of 2-4 generations]. / Caractéristiques du glaucome dans 13 familles de 2 à 4 générations.

OBJECTIVE: Heredity, one of the risk factors associated with primitive glaucoma, has not yet been studied in Togolese glaucoma patients. In this study, we report the characteristics and the modes of transmission of the family forms of glaucoma in 13 Togolese families. MATERIAL AND METHODS: From glaucomatous propositus and the presence of blindness unrelated to cataract in the ascendants, we carried out a family survey, drew up 13 family trees covering 2-4 generations in 190 participants. Screening based on tonometry and ophthalmoscopy made it possible, after perimetry, to confirm cases of glaucoma. RESULTS: Glaucomatous blindness was found in 4.2% of the subjects while 2.1% presented severe vision problems, for a total of 6.3% partially sighted persons due to glaucoma in the group of 190 participants. Glaucoma was confirmed in 57 participants (30%); 24.2% had a bilateral deficit compared to 5.8% with a unilateral perimetric deficit. Eight of the family trees covered four generations, four covered three generations, and two generations were covered in two family trees. Analysis of the trees led to the suspicion of a dominant autosomal transmission in six families, a recessive form in five families, and sporadic forms in two families. CONCLUSION: The presence of the hereditary family forms of glaucoma in 11 studied families out of 13 indicate a strong suspicion for the presence of a glaucoma gene; this can only be elucidated with a further study that would include genetic sequencing.