Safety and efficacy of unpreserved timolol 0.1% gel in patients controlled by preserved latanoprost with signs of ocular intolerance.

PURPOSE: To assess the safety and efficacy of unpreserved timolol 0.1% gel in ocular hypertensive (OHT) or glaucomatous patients controlled by preserved latanoprost 0.005% but with signs of ocular intolerance. METHODS: Patients initially treated with preserved latanoprost were randomized to receive once daily either one drop of unpreserved timolol gel in the morning or one drop of preserved latanoprost in the evening for 84 days. All patients attended three visits (D0, D28 and D84). A patient was considered as responder to primary criteria at Day 84 if the sum of the scores of the eight ocular symptoms and the six objective signs had decreased by at least 20% and if the effect on intra-ocular pressure (IOP) was assessed as either satisfactory or acceptable. RESULTS: At D84, 91.5% of patients were responders to the primary combined efficacy/safety criteria under unpreserved timolol gel treatment versus 48.6% under preserved latanoprost treatment (P<0.001). As early as D28, 85.3% of patients were responders in the unpreserved timolol gel group compared to 40.3% of patients in the preserved latanoprost group (P<0.001). IOP change from baseline was not significant between treatments (P>0.05) at D28 or D84. Both signs and symptoms were significantly improved (P<0.001) with unpreserved timolol gel compared to preserved latanoprost. CONCLUSION: Unpreserved timolol 0.1% gel maintained the efficacy of preserved latanoprost and reduced signs and symptoms of intolerance in almost all glaucomatous/OHT patients on preserved latanoprost.

Toxicity of French strains of the dinoflagellate Prorocentrum minimum experimental and natural contaminations of mussels.

Mediterranean strains of Prorocentrum minimum do not appear to have the same toxic component as Japanese strains since they showed no cytotoxicity for hepatocytes in culture. However, their toxic components, which appear to block calcium channels, were detectable by the immobilisation test on Diptera larvae. A bio-accumulation experiment in the laboratory showed that the toxins could accumulate in nearly equivalent amounts in the hepatopancreas and meat of cultured mussels. The same toxicity was found in natural samples collected in a period of bloom of P. minimum. These results suggest that P. minimum could be responsible for shellfish toxicity in the natural environment and thus present a risk for human health.

[Benign intracranial hypertension. Retrospective study of 20 cases]. / Hypertension intracrânienne bénigne. Etude rétrospective de 20 cas.

PURPOSE: We conducted a retrospective study in 20 cases of idiopathic intracranial hypertension (IIH) referred to the ophthalmology out-patients department at the Centre Hospitalier Universitaire of Fort de France. The objectives were to characterize symptomatology, severity, disease course and to discuss treatment. METHODS: We performed a complete ophthalmological and neurological examination, calculated the body mass index (BMI) and evaluated visual field. Each patient underwent a CT scan with injection and a lumbar punction with measurement of cerebrospinal fluid pressure. We also specified the treatment chosen and its duration, and the number of recurrences. RESULTS: This study included 20 cases, 19 women and 1 man, with a mean follow-up of 28.6 months. The average BMI was of 32.2 kg/m2. Fifteen patients out of 20 were obese (75%), all of them women, so 79% of the women were obese. Sixteen patients had headache (80%), 15 a loss of visual acuity (75%) and 5 transient visual loss (25%). For all the clinical examination showed bilateral papilloedema. Visual field disturbances were observed in 11 patients (73.3%). Papilloedema disappeared after medical treatment of a mean 2.4 months duration for each access. In 9 cases of 18 (50%) recurrences were observed after gradual treatment with-drawal. CONCLUSION: The long-term treatment, the side effects, the possible severity of the ocular disease, the difficulties of dietary restriction and the high rate of recurrence, would, for us, indicate a need to reconsider surgical treatment. We propose to perform lumboperitoneal shunt or optic nerve sheath decompression if medical treatment fails at the first onset of IIH or in case of severe visual loss, pregnancy or recurrence.

[Juvenile glaucoma. Seven case reports]. / Le glaucome juvénile. A propos de 7 cas.

BACKGROUND: Juvenile glaucoma is an uncommon form of chronic open angle glaucoma that appears between 3 and 35 years of age. METHODS: We report in this study seven cases of juvenile glaucoma that occurred in patients melanoderma. RESULTS: Three of them had unilateral blindness and in two others visual acuity was reduced to light perception in one eye. The intraocular pressure is above to 30 mmHg in 64.3% of the cases and a myopia was frequently associated. CONCLUSION: The insidious development of this pathology and the difficulty of its diagnosis among children often result in severe clinical manifestations with high visual field defects and optic disc cuppings particularly in melanoderma patients. Recent studies have proved autosomal dominant transmission with variable penetrance for one kind of juvenile glaucoma and location of the defective gene on chromosome 1q.

[Retinal vein occlusion and deep-sea diving]. / Occlusion veineuse rétinienne et plongée sous-marine.

We report a case of retinal vein occlusion after breath-holding diving. After one hour of diving at a maximal depth of eight meters, each apnea no longer than one minute, the patient complained of a diminution of the visual acuity in the left eye. Ophthalmological examination revealed an occlusion of the superior branch of the central vein of the retina in the left eye. This could be considered as a decompression sickness even if the occlusion could happen fortuitously in water. Secondary to the multiple descents, a bubble would have appeared in the vein leading to an obstruction. The purpose of this paper is to discuss a possible link between the breath-holding diving and this kind of accident. We also report the different ophthalmological features that may occur while diving.

[Bilateral optic neuropathy disclosing primary Gougerot-Sjögren syndrome]. / Une neuropathie optique bilatérale révélatrice d'un syndrome de Gougerot-Sjögren primitif.

A case of optic neuropathy and central nervous system disease developed in association with primary Sjögren's syndrome is described. Initial visual loss was partially reversible with intra veinous steroid therapy but four months later she underwent a controlateral visual loss and showed for the first time clinical manifestation of sicca syndrome. Fluorescein angiography showed signs of ischemic choroidopathy. Laboratory studies and histological findings on minor salivary gland biopsy was suggestive of primary Sjögren's syndrome. Attempts to taper oral steroid therapy resulted in worsening neurological disease and immunosuppressive therapy by azathioprine was successfully added to her regimen. Because of therapeutics and prognosis consequences, primary Sjögren's syndrome should be considered in differential diagnosis of optic neuropathy.

[Myocardial scintigraphy using technetium-99m labelled methylene diphosphonate in coronary care units. 82 cases]. / La scintigraphie myocardique au méthylène diphosphonate marqué par le technétium 99m en unité de soins intensifs coronariens. A propos de 82 observations.

Many isotopic methods have been proposed recently for the investigation of normal and diseased myocardium in ischaemic heart disease. The results of myocardial scintigraphy with Technetium 99 m marked methylene diphosphonate in the supine, left lateral and 30 degrees or 45 degrees right anterior oblique incidences are reported. A preliminary study of the tracer's fixation on diseased myocardium was performed in 18 patients. Scintigraphy every 30 minutes over a five hour period showed the optimal time for investigation to be situated between the third and fourth hour after the injection of the tracer. Seventy eight patients were then investigated; 82 scintigraphies were performed, 58 in patients with acute myocardial infarctions confirmed by the usual biological and electrocardiographic changes. A 74% sensitivity and 67% specificity were obtained with the methylene diphosphonate method. These figures varied according to the type of necrosis, subendocardial or transmural and with its extent, chronicity and degree of CPK elevation. Methylene diphosphonate scintigraphy would appear to be less sensitive and more specific for diseased myocardium than other isotopic methods. It may be carried out at the bedside and could improve the diagnosis of acute myocardial infarction when the clinical history and electrocardiographic changes are difficult to interpret.

[Evidence and properties of digestive proteases in young mugilidae during the first year of life]. / Mise en évidence et propriétés des protéases digestives chez les jeunes muges au cours de leur première année de vie.

Proteolytic activity was observed in extracts from the digestive tract of Mugil auratus and Mugil capito; its maximum occurs at about pH 2 and 9. Activity in the acid range is mainly found in stomach extracts and the enzyme may be considered as similar to pepsin and cathepsins. In the alkaline range, the main activity is recorded in the region of the pyloric caeca. Activities of the trypsin, chymotrypsin, A and B carboxypeptidases and elastase type are found. The effects of pH and temperature on some activities are studied: optimal pH are about 2.6 and 3,4 with pepsin-like activity, between 8,1 and 8,5 with trypsin-like activity and between 7,8 and 8,5 with chymotrypsin-like activity; incubation optimal temperature (pH 2,2) is found between 35 degrees and 40 degrees.