[Therapeutic observance and life of patients with primary open-angle glaucoma. Apropos of 341 cases in the department of Marne]. / Observance thérapeutique et vécu du glaucome primitif à angle ouvert. A propos de 341 cas dans la Marne.

Patient compliance with treatment is an important factor in chronic diseases such as primary open-angle glaucoma (POAG). Among the 404 glaucoma patients included in our study in the department of Marne (France), 341 patients responded by completing an anonymous questionnaire at home in which the psychological effect of the illness, their knowledge about it, compliance with treatment and their relationships with the physician were explored. Sixty-eight per cent of these patients confirmed strict compliance with the treatment prescribed; this rate does not vary with respect to either the ophthalmologist (p = 0.57), or the duration of treatment (p = 0.42). Half of the remaining patients only alter the hours of their treatment and 6% forget to instill the eyedrops on certain days. According to our survey, the principal causes of poor compliance are forgetfulness, time constraints with other duties, poor doctor-patient relationship and lack of sufficient knowledge about the disease and its treatment. The majority of patients (59%) are minimally disturbed by the treatment; 2/3 of the subjects do not feel any change in their moral whereas 15% are more depressed or weakened since the time the illness was discovered. Fifty-six per cent of them observed little or no change in their vision; 32% believe to have a moderate or considerable repercussion and 6% claim a very severe visual deterioration. Generally, patients appear to have a positive attitude towards their illness and do not try to deny it. Thirty-eight per cent of them consider it as a handicap which they can overcome and 42% have either no particular opinion or take it as a minor event.

[Epidemiological data on primary open-angle glaucoma and treatment in the department of Marne]. / Données épidémiologiques sur le GPAO et son traitement dans la Marne.

A descriptive cross-sectional epidemiological survey of primary open-angle glaucoma (POAG) was carried out in the department of Marne, France, between October 1990 and May 1991. The aim of the study was to obtain socio-medico-demographic data on glaucoma patients who were treated for a period of one year or more. Fifty per cent of the ophthalmologists in the department of Marne participated in the study by having their patients complete an anonymous questionnaire at home. Eighty-five per cent of the 407 patients replied. This response rate to the investigation did not vary significantly (p > 0.90) with respect to the ophthalmologist. However, forgetting to distribute the questionnaires to the patients was variable from one physician to the other. The prevalence of POAG cases undergoing treatment was between 0.15 and 0.36% for the whole population; between 0.37 and 0.89% for patients over the age of 40 years; 0.67 and 1.67% after the age of 60. The same number of women and men are affected, but the risk is 1.33 times greater for men after the age of 60. The geographical distribution of the patients is identical to that of the general population. Sixty-two per cent of the patients take other drugs as well and this proportion increases with age (p < 0.0001); 24% of the subjects have hypertension and 10.6% are diabetic. Half of the patients have received anti-glaucoma therapy for 6 years or less; 94% take beta-blockers, 18% take miotics and 12% use adrenergic drugs. More women instil their eyedrops on their own (79% vs 57%; p < 0.0001). Ten per cent of patients have had glaucoma operations and this proportion increases with age (p < 0.03). The frequency of laser treatment is 20%. Glaucoma patients seem to be faithful to their ophthalmologist as 65% of them go to the same one for follow-up. Our study shows that this type of investigation is well received by the patients.

[Endothelial effects of the ZB anterior chamber myopic implant during the first year. Prospective study with statistical analysis]. / Répercussions endothéliales de l'implant myopique de chambre antérieure ZB au cours de la première année. Etude prospective avec analyse statistique.

We conducted a prospective study of the corneal endothelium of 31 severely myopic eyes (17 patients) corrected by phakic anterior chamber intraocular lens. Patients were examined 3 months, 6 months and 12 months after surgical operation. In the center of the cornea, we noted a mean cell loss of 5.3% (p = 0.03) at 3 months, 8.2% (p less than 0.001) at 6 months and 15.5% at 12 months. The maximal cell loss was 21.6% at 3 months, 29% at 6 months and 58% at 12 months. The loss between 6 and 12 months was significant (p 0.01). In the periphery, the endothelial density was slightly lower than the central density (mean: 3.2%). In some cases, we saw areas of cellular denuding. It appeared that endothelial cell loss can be very different in the two eyes of the same patient, as well as between two different patients. Our study showed that the reduction of endothelial cell density was progressive with time. Intermittent contact between the implant and corneal endothelium was highly suspected, but this mechanism may not be the only one involved. The future integrity of these corneas is at stake and the problem of explantation of some implants is beginning to be a real one.

Addition of functional amiloride-sensitive components to the receptor membrane: a possible mechanism for altered taste responses during development.

The developmental increase in response sensitivity of rat peripheral taste afferents to NaCl and LiCl occurs concomitantly with an increase in sensitivity to the sodium ion transport blocker amiloride. Lingual application of amiloride had no effect on chorda tympani nerve taste responses to monochloride salts in early postnatal rats. However, amiloride suppressed NaCl and LiCl responses in proportion to the increased sensitivity to these stimuli during development in postweaning and adult rats without suppressing responses to NH4Cl and KCl.