Long-term efficacy of botulinum toxin A for treatment of blepharospasm, hemifacial spasm, and spastic entropion: a multicentre study using two drug-dose escalation indexes.

PURPOSE: To investigate the long-term effectiveness and safety of botulinum neurotoxin A (BoNT-A) treatment in patients with blepharospasm (BEB), hemifacial spasm (HFS), and entropion (EN) and to use for the first time two modified indexes, 'botulin toxin escalation index-U' (BEI-U) and 'botulin toxin escalation index percentage' (BEI-%), in the dose-escalation evaluation. METHODS: All patients in this multicentre study were followed for at least 10 years and main outcomes were clinical efficacy, duration of relief, BEI-U and BEI-%, and frequency of adverse events. RESULTS: BEB, HFS, and EN patients received a mean BoNT-A dose with a significant inter-group difference (P<0.0005, respectively). The mean (+/-SD) effect duration was statistically different (P=0.009) among three patient groups. Regarding the BoNT-A escalation indexes, the mean (+/-SD) values of BEI-U and BEI-% were statistically different (P=0.035 and 0.047, respectively) among the three groups. In BEB patients, the BEI-% was significantly increased in younger compared with older patients (P=0.008). The most frequent adverse events were upper lid ptosis, diplopia, ecchymosis, and localized bruising. CONCLUSIONS: This long-term multicentre study supports a high efficacy and good safety profile of BoNT-A for treatment of BEB, HFS, and EN. The BEI indexes indicate a significantly greater BoNT-A-dose escalation for BEB patients compared with HFS or EN patients and a significantly greater BEI-% in younger vsolder BEB patients. These results confirm a greater efficacy in the elderly and provide a framework for long-term studies with a more flexible and reliable evaluation of drug-dose escalation.

[Leber's optic neuropathy presenting as an alcohol- and tobacco-related optic neuropathy]. / Neuropathie optique de Leber se présentant comme une neuropathie optique alcoolo-tabagique.

The authors report a case of a 70-year-old man presenting a recent unilateral decrease in visual acuity, appearing in a context of alcohol and tobacco intoxication. Diagnosis of Leber's optic neuropathy was evoked after elimination of other causes of a visual acuity decrease such as giant cell arteritis and compressive or inflammatory optic neuropathy. The authors emphasize that Leber's optic neuropathy must be evoked in a recent decrease in visual acuity, even if it appears in an unusual context.

[Evaluation by laser flare meter of the inflammatory response after cataract surgery]. / Evaluation par laser flare meter de la réponse inflammatoire après chirurgie de la cataracte.

PURPOSE: To prospectively evaluate use of the laser flare meter the inflammatory response after phacoemulsification with four different types of intraocular lenses. METHODS: Measurements with the Kowa laser flare meter FC-500 were done before surgery and at 1, 6 and 21 days following standard phacoemulsification with corneal incision in 157 patients. The patients were randomized in four groups to receive HSM IOL (group I), foldable acrylic IOL (group II), foldable three-piece silicone (group III), and foldable single-piece silicone (group IV). RESULTS: Overall, mean flare values were increased at D1, and decreased rapidly to normal values at D21. Intragroup analysis showed a slight increase of flare value observed in the PMMA group (p = 0.0015) and silicone monobloc group (p = 0.001) at D21 compared to D0. There was no statistical difference found between D0 and D21 in the acrylic and the silicone three pieces groups. At D1, a significant increase of flare values was observed in the PMMA (28.9 ph/ms) and silicone three pieces (28.8 ph/ms) groups, as compared to silicone monobloc group (22 ph/ms). At D21, the acrylic group had a significantly lower mean value than PMMA and silicone monobloc groups. No statistical difference was observed between acrylic and three-piece silicone at D21. CONCLUSION: This study shows that the inflammation in the four groups was very low after phacoemulsification by a corneal incision and attempts to explain the impact of the incision length on the breakdown of blood-aqueous barrier.

[Abnormalities of the ocular surface in patients with AIDS]. / Anomalies de la surface oculaire chez les patients atteints de SIDA.

PURPOSE: AIDS patients more and more complain from conjunctival symptoms related to dry eyes and conjunctivitis, but little is known about ocular surface abnormalities in these patients. We used impression cytology (IC) and tear IgE to assess inflammatory status of the ocular surface in AIDS. METHODS: IC were taken in 30 patients infected by HIV (including 28 AIDS patients). After collecting general clinical information, and CD4 rate, we made a complete ophthalmological examination (Schirmer test, BUT, Lissamine green and tear IgE). IC were processed by an immunofluorescence technique with antibodies to HLA DR: an inflammatory marker normally restricted to conjunctival dendritic cells; and to APO 2.7 an apoptotic cell marker. RESULTS: Seventy per cent suffered from subjective and/or objective signs, and BUT was abnormal in 70% of patients. Tear IgE was increased in 36% of the eyes, even without known allergy. A decrease in density of dendritic cells and an abnormal expression of HLA DR antigens by epithelial cells were common features in both groups (respectively 90% and 80% of the eyes). An increase of the APO 2.7 marker was significantly found in 70% of eyes. We found no correlation between clinical abnormalities and laboratory findings. However there was a correlation between the blood CD4 decrease and the HLA DR antigen overexpression. Tear IgE were related to HLA DR expression. CONCLUSION: This work shows that even when AIDS patients are asymptomatic they may present significant alterations of the ocular surface probably due to their immunological disorders.