[Rhinoconjunctivitis: importance of a local diagnosis?]. / Rhinoconjonctivites: intérêt d'un diagnostic local?

Diagnosis of allergic rhinoconjunctivitis, particularly in chronic forms, remains sometimes difficult. Systemic tests such as skin or blood tests may be not sufficient to assess local sensitization. Local tests are needed, performed from nasal secretion or tears. Measurement of total IgE in the local secretions of 41 patients suffering from rhinoconjunctivitis show that diagnosis contribution was upgraded from 61 to 88%. Very interestingly, in some cases, local tests were the only argument for allergy.

Comparison of lodoxamide 0.1% ophthalmic solution and levocabastine 0.05% ophthalmic suspension in vernal keratoconjunctivitis.

PURPOSE: To compare the clinical efficacy and safety of lodoxamide 0.1% ophthalmic solution with levocabastine 0.05% ophthalmic suspension, each given four times daily (QID) for three months to patients with vernal keratoconjunctivitis (VKC). METHODS: The study was conducted multinationally according to a triple-masked parallel design in 95 VKC patients, with assessments at baseline then monthly during the three months of treatment. The primary efficacy variables were a Physician's Clinical Judgement Scale and a Patient's Overall Judgement Scale of improvements from baseline. Signs and symptoms of VKC were also assessed. RESULTS: Both primary efficacy variables showed significantly greater overall improvement of VKC from baseline with lodoxamide than levocabastine. The superiority of lodoxamide was demonstrated by the Physician's Clinical Judgement Scale at months 2 and 3, with a trend, at month 1, and by the Patient's Overall Judgement Scale at months 1, 2 and 3. All signs and symptoms of VKC improved significantly from baseline at all time points, regardless of treatment (p<0.001). However, relative to levocabastine, conjunctival discharge, photophobia and lacrimation were significantly reduced by lodoxamide at months 1, 2 and 3, itching at months 2 and 3, and bulbar conjunctiva at month 3. The temporal improvement of superior tarsal papillae did not differ significantly between treatments. Both were well tolerated. CONCLUSIONS: Lodoxamide 0.1% and levocabastine 0.05% eye drops, instilled four times daily for three months, were effective, safe and well tolerated by patients with VKC, but lodoxamide was significantly superior to levocabastine.

Multiple sclerosis associated with uveitis in two large clinic-based series.

The authors reviewed records from consecutive patients in an MS clinic (n = 1,098) and in a uveitis clinic (n = 1,530) to select patients with "definite MS" and uveitis. A total of 28 of 2,628 patients (1%) were identified: 12 from the MS clinic (12 of 1,098; 1.1%) and 16 from the uveitis clinic (16 of 1,530; 1%). Pars planitis and panuveitis were most commonly encountered. The delay between the onset of neurologic and ocular symptoms (mean, 9 years) emphasizes the importance of a sequential diagnostic search throughout the patient's course.

Comparison of topical 0.05% levocabastine and 0.1% lodoxamide in patients with allergic conjunctivitis. Study Group.

PURPOSE: The aim of the study was to assess the efficacy and safety of 0.05% levocabastine eyedrops (H1 receptor blocker given BID + vehicle BID) compared with 0.1% lodoxamide ophthalmic solution (mast-cell stabilizer instilled QID) in reducing ocular signs and symptoms of allergic conjunctivitis. METHODS: A randomized, double-masked, parallel-group study was conducted in seven centres in France, in which 93 patients suffering from seasonal or perennial allergic conjunctivitis were randomly allocated to either 0.05% levocabastine (n = 47) or 0.1% lodoxamide (n = 46) in both eyes for a 14-day period. Efficacy was evaluated by subjective (prickling, burning, photophobia, itching) and objective (redness, chemosis, eyelid edema, tearing) sign scores at visits on days 7 and 14, and from data noted daily by the patient in a self-evaluation form. Safety was assessed as tolerance upon instillation and adverse event reports. RESULTS: The ocular allergy symptom and sign scores were comparable in the two treatment groups at baseline. With time, statistically and clinically significant reductions (p < 0.001) from baseline were observed for the subjective and objective scores, with no difference between the treatment groups. After the first instillation, signs were alleviated more rapidly in levocabastine-treated patients than in the lodoxamide group (p < 0.001). Overall assessments by the patient and investigator were similar in both groups. No serious adverse events were reported. CONCLUSIONS: Levocabastine ophthalmic suspension 0.05% (BID) appears to be as effective and safe as lodoxamide 0.1% (QID) in the management of allergic conjunctivitis.

Treatment of common ocular allergic disorders; a comparison of lodoxamide and NAAGA.

BACKGROUND/AIMS: Lodoxamide tromethamine and N-acetyl-aspartyl glutamic acid (NAAGA) are mast cell stabilisers, both of which have been shown to be effective in the treatment of allergic conjunctivitis. The aim of this study was to compare the two compounds in patients with common ocular allergic disorders. METHODS: 73 patients participated in a double masked, randomised multicentre study. Diagnoses were chronic allergic conjunctivitis, vernal conjunctivitis, seasonal and atopic conjunctivitis. 36 patients were treated with lodoxamide 0.1% and 37 with NAAGA 4.9%, the drops being instilled four times daily for up to 56 days. RESULTS: The overall opinion of the physicians and the patients was in favour of lodoxamide at day 10 of the study. At this time, 86% of lodoxamide treated and 49% of NAAGA treated patients considered they had improved. The patients' opinion favoured lodoxamide at day 28 and both physicians' and patients' evaluations were in favour of lodoxamide at day 42. Evaluation of signs and symptoms indicated superiority of lodoxamide at days 42 and 56. Both treatments were well tolerated. CONCLUSION: While both lodoxamide and NAAGA treatments are associated with clinical improvements in patients with allergic conjunctivitis, lodoxamide may have an earlier onset of action.

Local production of IgG and IgG subclasses in the aqueous humor of patients with Fuchs heterochromic cyclitis, herpetic uveitis and toxoplasmic chorioretinitis.

Changes in local immunity are important when considering the physiopathology of uveitis. The aim of this study was to measure IgG and IgG subclass concentrations in the serum and the AH of patients with three different types of uveitis and to determine for each of them the presence of a local production of IgG in the intra-ocular compartment. This investigation was extended to IgG subclasses. Serum and AH of 46 patients, including 11 with Fuchs heterochromic cyclitis (FHC), 13 with toxoplasmic chorioretinitis, 11 with herpetic uveitis and 11 with senile cataract (taken as controls) were analyzed by ELISA for IgG and IgG subclasses. Three quotients (r1, IgG/albumin in serum; r2, IgG/albumin in AH; and R, r2/r1) were calculated in order to estimate the local synthesis (LS) of IgG and each IgG subclass. In AH of patients with herpetic uveitis, a concomitant and significant increase of all IgG subclasses as well as albumin (with no significant increase of r2 or R) was observed. This finding was interpreted as an indirect consequence of major damage to the blood-aqueous barrier. In patients with FHC, a significant increase of r2 and R involving only the IgG1 subclass was observed, indicating the existence of LS of IgG1 in the majority of these patients. In the AH of patients with toxoplasmic chorioretinitis, no significant modification of IgG subclass or albumin concentrations was observed when compared to controls. In conclusion, it would seem interesting to consider measurement of IgG and IgG subclasses and calculation of the coefficients r1, r2 and R for a better evaluation of the local immunological processes observed in different types of uveitis.

[Observatoire des Allergies Oculaires. National epidemiological survey of chronic (perennial) allergic conjunctivitis and/or keratoconjunctivitis seen in ophthalmology]. / Observatoire des Allergies Oculaires. Enquête épidémiologique nationale sur les conjonctivites et/ou kérato-conjonctivities allergiques chroniques (per-annuelles) suivies en ophtalmologie.

A second epidemiological ocular allergy survey was carried out by ophthalmologists during the winter of 94/95 in order to define the main characteristics of patients suffering from chronic, perennial allergic conjunctivitis or keratoconjunctivitis. From the data collected from a wide sample of 791 patients, we were able to describe the main symptoms and lesions related to chronic ocular allergy, its evolution and the allergens involved. Allergic symptoms (conjunctival redness, foreign body sensation, itching) are reported in 98.5% of patients. Non specific symptoms (burning, photophobia, blurred vision, ocular dryness) are reported in 3 patients out of 4. 40% of patients have perennial manifestations without any seasonal exacerbation while 1 patient in 2 suffers from a seasonal worsening. In 80% of the cases, the responsible allergens are domestic (house dust, miles), 60% of patients are affected by at least 2 allergens. Ophthalmic examination shows lesions of the tarsal conjunctiva (papillas, follicles) in 94% of the cases and corneal lesions in practically 50% of the patients. This epidemiological survey shows the necessity of having a rigourous clinical approach which includes a complete ophthalmological examination which is the only thorough means of assessing the allergic lesions and proposing the most suitable treatment for day to day ophthalmic practice.

[Ocular Allergy Observatory. National epidemiological survey of seasonal allergic keratoconjunctivitis seen in ophthalmology]. / Observatoire des Allergies Oculaires. Enquête épidémiologique nationale sur les kératoconjonctivites allergiques saisonnières vues en ophtalmologie.

The main objective of this first epidemiological ocular allergy survey was to precise the profile of patients with an ocular allergy, especially in terms of antecedents, clinical type and trigger or favourising factors, in order to better determine the evolution of the type of diagnosed allergy. This survey covered 399 sufferers drown from amongst general ophthalmologists patients consulting for ocular allergy. Three main points which came out of the survey were: - the chronic aspect of this pathology and the multiplicity of responsible allergens; - the almost permanent existence of conjunctival lesions (9 patients out of 10) and corneal epithelial disease (1 patient out of 3); - the need for an extremely rigourous and thorough questioning of the patient and a complete ophthalmologic examination covering not only the symptoms but equally the lesions of ocular allergy.

[Acute retinal necrosis syndrome. Retrospective study apropos of 14 eyes in 11 patients]. / Le syndrome de nécrose rétinienne aiguë. Etude rétrospective à propos de 14 yeux de 11 patients.

PURPOSE: The authors present a retrospective study of fourteen eyes of eleven patients suffering from acute retinal necrosis syndrome (ARN) and compare the results with previously published data. MATERIAL AND METHODS: All patients were referred to us between 1985 and 1993. The results of initial examination, the epidemiological and aetiologic data, as well as the clinical course and treatment are summarized in two tables. RESULTS: First clinical examination found a prominent ocular inflammatory reaction, several sites of peripheral retinal necrosis and one retinal vasculopathy. Bilateralisation occurred in 28% of the patients. An optic neuropathy developed in 57% of the cases, and a retinal detachment in 78%. Initial examination and data on the clinical course are discussed and compared with those described in the literature. CONCLUSION: The results of the current study are representative of the various clinical and biological profiles of acute retinal necrosis and are similar to those described in previous publications. Earlier care in specialized departments of ophthalmology should allow a better anatomical and functional prognosis in the future.

[Fluorophotometry of changes of hemato-ocular barriers in intermediate uveitis]. / Etude en fluorophotométrie de l'altération des barrières hémato-oculaires au cours de l'uvéite intermédiaire.

PURPOSE: Intermediate uveitis presents a characteristic clinical picture with inflammation in the vitreous and peripheral retina. From a physiological point of view, the disease is characterised by a rupture of blood-ocular barriers. To determine the sites involved, a vitreous fluorophotometry was performed in patients with intermediate uveitis and in a group of healthy patients. METHODS: Seventy-one patients with an intermediate uveitis were studied by vitreous fluorophotometry. Anterior chamber and posterior segment fluorophotometric findings were measured 5 and 60 minutes after injection of fluorescein. Results were compared to a group of healthy patients. RESULTS: Vitreous fluorophotometry demonstrated abnormal leakage of fluorescein in all vitreous sectors of the patients suffering from uveitis compared with the control group (p < 0.001). In the anterior chamber, leakage of fluorescein was not significantly different between the two groups (p > 0.05). CONCLUSION: Results obtained suggest that intermediate uveitis involves a generalized permeability disturbance of the posterior segment secondary to a diffuse vasculitis. However, in the anterior segment this disturbance is not found.

Amsler's sign associated significantly with Fuch's heterochromic cyclitis (FHC).

To investigate the frequency and diagnostic significance of Amsler's sign in patients with Fuch's heterochromic cyclitis (FHC), we performed a diagnostic AC puncture of the eyes of 31 patients with this disease and looked for the same sign in 104 patients with intermediate uveitis and 373 patients with various other types of uveitis who underwent the same procedure. AS was significantly more frequent in the FHC patients than in either of the other two groups of patients, and occurred infrequently in all other types of chronic uveitis. We therefore consider its occurrence to have important differential diagnostic value. We would also emphasize the pathophysiologic significance of AS and suggest that this aspect be investigated in the future.

Tear IgE detected by a new method: Stallerdiag-IgE.

A new method for the tear IgE measurement Stallerdiag-IgE is presented. For this assay, the tears are collected on a strip of filter paper introduced into the conjunctival cul-de-sac. Then the IgE are measured by a simple enzymo-immunological assay. Tear IgE were determined in a normal population and in three groups of patients with keratoconjunctivitis. In the normal population, the tear IgE level is 0.37±0.66 kIU/1. The IgE level observed in the patients with vernal keratoconjunctivitis (19.6±21.5 kIU/1) or chronic allergic keratoconjunctivitis (11.1±16.2 kIU/1) is significantly different (p<0.0005) from the IgE level measured in the patients suffering from non-allergic keratoconjunctivitis (3.4±10.4 kIU/1). By comparison with a non-allergic group, the sensitivity is 80%, the specificity is 89% giving an overall efficiency of 83%.

[Origin of uveitis]. / Origine des uvéites.

Uveïtis are remarkable for the diversity of their clinical forms, as well as for the variety of their origins. Their precise aetiological research, which sometimes needs further investigations, is only found, on average, in 50% of the cases. While filling uveïtis according to the eye-zone especially affected, we are explaining the principal known causes.

[Viral uveitis]. / Uvéites virales.

The role of neurotropic virus in the etiopathogeny of uveitis is being emphasized by recent findings. Serology of aqueous humor is the first step towards the diagnosis since it indicates in many cases a local production of specific antibodies. Different entities seem to correspond to different viral specificities. The relationship between measles virus and multiple sclerosis may be one of the most fascinating aspects of this problem.

[Treatment of herpetic endogenous uveitis with acyclovir by the systemic route]. / Traitement des uvéites endogènes herpétiques par l'acyclovir administré par voie générale.

Seventeen patients with presumed chronic herpetic uveitis of all anatomic types underwent systemic treatment with oral and/or intravenous, acyclovir. The diagnosis of herpes had been established on data from serological tests of the aqueous humor. Results were judged according to corticodependance and visual acuity. Results were all the more positive as treatment was more prolonged and also correlated with the dose of acyclovir injected intravenously or taken orally every day. Follow-up ranged from 6 months to several years.

Biological modifications of the vitreous in intraocular parasitosis: preliminary study.

In intraocular parasitosis the immunologic reactions in the vitrectomy-fluids depend on the parasitic agent: there is a lymphocytical reaction without any IgE production in toxoplasmic chorioretinitis, whereas there is a strong hypersensitivity reaction with a local IgE production as well as the presence of eosinophils and an antigenic stimulation in fluids with toxocara parasitosis. The electrophoretic patterns are quite similar in both cases.

[Orbital invasiveness of Merkel cell tumor of the eyelid]. / Envahissement orbitaire d'une tumeur à cellules de Merkel palpébrale.

A new case of neuroendocrine carcinoma (Merkel cell tumor) of the eyelid is reported. Local recurrence, spread to the orbit, led to exenteration and death of the patient. This trabecular carcinoma can be identified by histology, immuno-histochemistry and electron structural microscopy.