Efficacy and safety of preservative-free timolol 0.1% gel in open-angle glaucoma and ocular hypertension in treatment-naïve patients and patients intolerant to other hypotensive medications.

GOALS: To assess the efficacy and safety of preservative-free timolol 0.1% gel in patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT). METHODS: In this multicenter, open-label, non-controlled clinical trial in Algeria, treatment-naïve patients with intraocular pressure (IOP)>20mmHg and<31mmHg (treatment-naïve patients, group 1) and patients with IOP controlled by current ocular monotherapy but presenting with local intolerance in at least one eye (intolerant patients; group 2) were eligible. Timolol gel was administered once daily in the morning for 84 days. The primary efficacy criteria were reduction in IOP (group 1) and maintenance of baseline IOP (group 2). RESULTS: Overall, 93 patients were included (53 in group 1, 40 in group 2). All patients in group 2 had been previously treated with preserved eye drops. In group 1, patients showed a significant reduction in IOP with mean changes in the worse eye of -10.3±3.0mmHg at D28 and -10.8±2.5mmHg at D84 (P<0.0001). In group 2, the maintenance of efficacy on IOP at D84 was satisfactory in 91.7% of patients (worse eye). Preservative-free timolol gel was well tolerated in both groups. In group 2, the overall symptom score was significantly reduced from 8.6±5.1 to 0.9±1.6 at D28 and 0.7±1.2 at D84 (P<0.0001), and the overall ocular sign score from 3.7±2.1 to 0.8±1.0 at D28 and 0.6±0.8 at D84 (P<0.0001). CONCLUSIONS: This preservative-free timolol 0.1% gel was effective in decreasing IOP in treatment-naïve patients and in controlling IOP and reducing ocular signs and symptoms in patients intolerant to their previous preserved medications.

[Frequency and risk factors for diabetic macular edema in the wilaya of Constantine (Algeria)]. / Fréquence et facteurs de risque de l'œdème maculaire diabétique dans la wilaya de Constantine (Algérie).

We conducted an exhaustive cross-sectional descriptive study, in 2009, on type 1 diabetics residing in the wilaya of Constantine. Our objective was to assess the frequency and risk factors associated with diabetic macular edema (DME) by mydriatic non-stereoscopic fundus photographs of nine retinal fields. The frequency of DME was 8.7%. There was no gender influence on the frequency of macular edema. There were as many men (46.4%) as women (53.6%) with ME (P = 0.8). On bivariate analysis, the duration of diabetes (P = 0.001), age (P = 0.0001), hypertension (P = 0.00001), renal involvement (P = 0.00001) and hypercholesterolemia (P = 0.01) were risk factors for DME.

[Cilioretinal artery occlusion and central retinal vein occlusion complicating hyperhomocysteinemia: a case report]. / Occlusion mixte : de l'artère ciliorétinienne et de la veine centrale de la rétine par hyperhomocystéinémie (à propos d'un cas).

INTRODUCTION: Hyperhomocysteinemia is known to be a risk factor in both retinal artery and retinal vein occlusions. We report the case of a young patient with combined occlusion of the cilioretinal artery and the central retinal vein due to hyperhomocysteinemia. PATIENTS AND METHODS: A 23-year-old patient without significant medical history, presented for sudden, painless visual loss in the right eye. Ophthalmologic examination revealed best-corrected visual acuity of the right eye 8/10 P2, and 10/10 P2 on the left. Anterior segment exam was normal in both eyes, while the right fundus revealed white, ischemic edema, centered around a cilioretinal artery, sparing the fovea, with some hemorrhagic spots and disc edema. Fluorescein angiography confirmed delayed filling of the right cilioretinal artery and revealed a normal disc on the left. Two weeks later, the clinical picture had evolved into a right ischemic CRVO, confirmed by a second angiogram, with a decrease in visual acuity to 3/10. RESULTS: A work-up was performed, including: a full lipid profile, serum electrolytes, ESR, CRP, a complete blood count (leukocytes, platelets, hemoglobin were normal), a coagulation work-up (PT, PTT, protein C, protein S, antithrombin III, factor V Leiden were normal), ANCA, antiphospholipid antibodies and antinuclear antibodies were negative, and finally cardiology studies (cardiac echo, carotid Doppler) and neurology (brain MRI) were ordered and came back normal. Otherwise, plasma homocysteine was moderately high on two samples, at 18.3 µmol/L and 17.78 µmol/L. Thyroid and renal work-ups were ordered. Urgent PRP was performed, and vitamin therapy (vitB12, vitB6, folic acid) was instituted. The subsequent course was remarkable for recovery of visual acuity to 10/10, P2 with persistence of an inferior altitudinal central scotoma. MTHFR C677T polymorphism was negative. DISCUSSION: Retinal vascular occlusions (RVO) are serious events, which require investigation for underlying systemic disease, which can be life-threatening. The clinical picture is variable depending on the location of the occlusion, the extent of the ischemic area and the degree of macular involvement. The etiologies of RVO are varied, requiring a thorough biological assessment in young subjects. The association between hyperhomocysteinemia and RVO is proven, while this association with the MTHFR C677T polymorphism was not found. Vitamin therapy reduces plasma levels of homocysteine by 25% but its role in the treatment and prevention of RVO remains to be demonstrated. CONCLUSION: Several cases of occlusion of the central retinal vein or one of its branches have been published. Combined occlusion of the central retinal vein and cilioretinal artery secondary to hyperhomocysteinemia does not appear to have been published, which would make our case unique.

[Surgical treatment of sequelae of oculomotor paralysis of the 4th, 6th, and 3d cranial nerves]. / Traitement chirurgical des paralysies oculomotrices séquellaires des IV, VI, III.

The writers analyse the operative results of 43 cases of oculo-motor paralysis aftermaths of the 4th, 6th and 3rd cranial pairs treated since 1985. The applying of muscular puckering, associated with a controlled or kept tenotomy, of muscular transplant, of "Fadenoperation" and of oblique surgery, allowed to obtain good results with suppression of diplopia, at least in the facing and in the lower glance, attenuation of ocular torticollis, disappearing of the ocular deviation, and restitution of a fusion area in primary position, within a more or less extended zone of space.