The characteristics of conflict of interest in the doctor's pharmaceutical representative Relationship.

INTRODUCTION: Studies addressed the influence of pharmaceutical representatives in drug prescribing habits, in terms of quality and quantity. AIM: To describe the representatives' strategies, assess their impact on medical prescribing, and study the various factors influencing doctors' prescribing changes. METHODS: We conducted a cross-sectional study including 70 participants. All of them had an anonymous questionnaire to determine their socio-demographic data, the pharmaceutical representative visits details, the influence of gifts on the medical prescription, and the predictive factors of this influence. We also analyzed the solutions to alleviate the conflict of interest. RESULTS: We found that 52.8% of participants thought that gifts were the source of an ethical dilemma and 85.7% of them thought that the priority of the pharmaceutical representative was the promotion of the product rather than the scientific interest. However, 68.5% of them thought that the gifts were useful and therefore we can continue to receive them. Nineteen participants (27.1% of cases) thought that gifts can modify their medical prescription. However, there were significantly more subjects (p=0.049) who thought that other colleagues would be more influenced (72.8%). Factors that favor the prescription changing by gifts, were age (p=0.002, OR=1.2) and the number of visits per month (p=0.015, OR=8.8). CONCLUSIONS: There is a discrepancy between the growing awareness of this ethical issue and the daily practices of physicians who continue to accept gifts. The absence of training in bioethics explains these results.

Risk Factors for Ocular Surface Disease in Tunisian Users of Preserved Antiglaucomatous Eye Drops.

PURPOSE: To study the clinical and the functional findings in glaucomatous patients under preserved eye drops having ocular surface alterations and to analyze their risk factors. METHODS: A cross-sectional study of 155 glaucomatous patients was conducted. All of them answered the "Ocular Surface Disease Index" (OSDI) questionnaire and had a complete and precise evaluation of the ocular surface state including a Schirmer I test, a tear break-up time evaluation, eyelid, conjunctival, and corneal examination with a Fluorescein and a Lissamin green test. We studied factors that could influence the OSDI score and each type of ocular surface alteration (age, sex, glaucoma treatment duration, number and type of the active principle, and Benzalkonium Chloride [BAK] use). RESULTS: BAK was used in 80% of cases. The OSDI score was ≥13, in 61.3% of cases. The biomicroscopic signs of ocular surface disease were at least minimal in 87.1% of cases. The main predictors of OSDI score increase were the glaucoma treatment duration (P = 0.01, t = 2.618), the number of molecules used (P = 0.018, t = 2.391), and the use of BAK (P = 0.011, t = 2.58). The severity of the biomicroscopic signs correlated with these same risk factors. Fixed combination was statistically associated with a lower incidence of superficial punctate keratitis (SPK) and corneal and conjunctival staining in the Lissamine green test (P < 0.001). Beta-blockers were associated with a significantly higher risk of SPK and corneal or conjunctival staining in the Lissamine green test (P < 0.001). CONCLUSIONS: Preserved antiglaucomatous eye drops alter the patients' ocular surface. The main risk factors were advanced age, duration of glaucoma treatment, multiple therapies, and the use of BAK.

Optical coherence tomography angiography microvascular changes in diabetics without diabetic retinopathy.

PURPOSE: The purpose of this study was to analyze the retinal vasculature of diabetic eyes without clinical retinopathy in order to detect microvascular abnormalities, comparing them to that of healthy nondiabetic control eyes. METHODS: This is a prospective, cross-sectional study including 40 patients (76 eyes). Twenty patients (40 eyes) were diabetics with no diabetic retinopathy group (NDRG). The twenty other patients (36 eyes) were nondiabetic and constituted the control group (CG). Images were obtained using the AngioVue optical coherence tomography angiography (OCTA) software of RTVue XR spectral-domain OCT device. We performed 3 mm × 3 mm and 6 mm × 6 mm scans to evaluate the foveolar avascular zone (foveal) size, a remodeling of the FAZ, microaneurysms, vessel tortuosity, and superficial vascular density. All statistics were performed using IBM SPSS statistics (version 21). RESULTS: The average FAZ size was 314.6 ± 15.3 µm in the NDRG versus 291.5 ± 14.1 in the CG. The difference was not significant (P = 0.56). FAZ remodeling was noted in 40% of eyes in the NDRG and in 2.8% of eyes in the CG (P = 0.0001). Flow alteration zones (nonperfusion zones) were seen in 77.5% in the NDRG (P = 0.0001). Microaneurysms were present only in the NDRG (70% of eyes). Parafoveolar vascular density was 52.8% ± 0.7% in the NDRG and 54.1% ± 0.25% in the CG but without significant difference (P = 0.206), and vascular tortuosity was significantly present in the NDRG with 32.5% of eyes versus 11.1% of eyes in the CG (P = 0.003). CONCLUSION: OCTA is a promising tool to identify microvascular changes in the diabetic retina before clinically visible retinopathy occurrence. It may identify in the future individuals at risk of developing retinopathy and therefore those needing a better balance of diabetes.

Unilateral proptosis revealing a fronto-ethmoidal mucocele.

Backgroud: The fronto-ethmoidal mucocele is a benign condition leading commonly to limited eye movement or ocular pain but it could also induce visual acuity impairment by compressing the optic nerve Aim: To discuss, through a case report, different ophthalmologic manifestations of the fronto-ethmoidalmucocele. Reported case: A 46-years-old man with no general history consulted for a bilateral ocular redness and itching. He reported, however, a mild protrusion of his left globe evolving for oneyear. The clinical examination revealed a unilateral proptosis in the left eye with a discrete limitation of theadduction. A brain and orbital computer tomography (CT)and a magnetic resonance imaging(MRI)revealed a grade I exophthalmos caused by an oval formation of fluid density in the left anterior and posterior ethmoidal cells in addition to the frontal sinus,driving theeyeball and internal oculomotor muscles back and out.The patient was referred to otorhinolaryngology department for a precocious surgical management. CONCLUSION: The ophtalmologic manifestations of the disease depend on the location, the size of the formation and involvement of adjacent structures. The loss of vision and the apex syndrome due to the compressionof the ocular globe are the most serious complications.

Antiglaucomatous treatments and ocular surface.

BACKGROUND: the antiglaucomatous treatments interact with the ocular surface and can induce its alteration which may affect the therapeutic results Aim : to describe the interactions between the ocular surface and anti-glaucoma medications and to propose practical attitudes to prevent and manage this issue. METHODS: a retrospective study about 100 patients with a primary opened angle glaucoma treated with anti-glaucomatous drops containing preservatives. We performed an exhaustive examination of the ocular surface with fluorescein instillation to search superficial punctuate keratitis and to evaluate the break up time. All patients had a Schirmer test I. RESULTS: our patients were under monotherapy in 46% ,two medications in 36%, three medications in 11% and four medications in 7% .Beta-blockers were statistically related to the conjunctival hyperaemia (p = 0.014), BUT alteration (p = 0.001) and Schirmer test ≤ 5 mm (p = 0.0001). Prostaglandin analogues were statistically related to a Schirmer test ≤ 5 mm (p = 0.02). The use of more than two anti-glaucomatous medications was linked to the severity of the clinical signs. CONCLUSIONS: anti glaucoma drops affect the ocular surface through several mechanisms: allergic reaction, direct and indirect toxicity of the active agents as well as their preservatives. The risk is increased by the prior ocular surface abnormalities in these patients. This disease influences the quality of life and leads to poor adherence to treatment.

Incontinentia pigmenti: a rare cause of retinal vasculitis in children.

BACKGROUND: Incontinentia pigmenti is a genetic disease with cutaneous, dental, neurologic and ophthalmologic manifestations. Ocular changes are very varied. Retinal vasculitis is uncommon, but can be observed in this disease. AIM: To report a case of a patient with retinal vasculitis associated to incontinentia pigmenti. REPORT: A seven year old girl was followed for cutaneous lesions with the diagnosis of incontinentia pigmenti confirmed by a skin biopsy. She had delayed eruption of her teeth some of which were conical. She had no neurologic nor developmental abnormalities. Ophthalmological examination and fluorescein angiography was performed and showed retinal neovascularization in the left eye, secondary to retinal ischemia and retinal sequelae vasculitis without inflammation or complications in the right eye. Laser photocoagulation was indicated to the left and a strict surveillance to the right eye. After one month of the beginning of treatment, we noticed an involution of the retinal neovascularisation. CONCLUSION: Early diagnosis and management of retinal changes in incontinentia pigmenti is essential because they may be serious leading to blindness.

[Ocular findings in megaloblastic anemia associated with diabetes. A case report]. / Complications oculaires de l'association anemie de biermer et diabete. A propos d'un cas.

Ocular involvements of Biermer's anaemia are rarely reported in literature. We present a case of Biermer's anaemia associated with diabetes. Ocular examination showed important conjinctival paleness, diffuse retinal ischemia, Roth's tasks, macular oedema and ischemic optic neuropathy. The patient was treated with vitamin B12 intramusculary. A month later, on examination, we noted a regression of optic neuropathy, the aggravation of ischemic retinopathy and persistence of macular oedema. The patient was treated with laser photocoagulation. The majority of ocular manifestations are reversible if treatment is underlaken early. The combination of diabetes with Biermer's anemia deteriorates the ischemic retinopathy and aggavates its prognosis.

[Lofgren syndrome revealed by eyelid tumor]. / Syndrome de Löfgren revele par une tumeur palpebrale.

INTRODUCTION: The Lofgren syndrom is a particular variety of sarcoidose. The ocular attack is dominated in this syndrome by anterior uveitis. More rarely the eyelids and the orbitary structures are attached. PURPOSE: In this work, we report a Lofgren syndrome case revealed by eyelid tumor. OBSERVATION: It is about 42 year-old patient who consults for a right inferior eye-lid tumefaction developped for 2 months. The diagnosis of Lofgren syndrome was evoqued because of the association of fever, arthritis, erythema nodosum, tuberculin anergia, hypercalcinuria and mediastinal adenopathy at thoracic scan-tomography. The diagnosis was then confirmed by biopsy of palpebral tumor which showed multiple epithelioid and gigantocellular granuloma without caseous necrosis. CONCLUSION: The Lofgren syndrome is a multivisceral chronic affection. The eye and its annexes constitute frequent cibles of this affection for which they react by a diverse and rich symptomalogy and which can be presented by eye-lid tumors with orbital extension.