[Efficacy and safety of a fluid carbomer gel versus a conventional carbomer gel in dry eye treatment]. / Efficacité et tolérance d'un gel de carbomère fluide versus un gel de carbomère classique lors du traitement du syndrome sec.

AIM: To compare the risk/benefit for C974P (a 0.25% fluid carbomer gel in a vial allowing dropwise instillation) versus a conventional carbomer gel. MATERIAL AND METHODS: During this multicenter, randomized, investigator-masked trial, patients with dry eye syndrome were treated with C974P or C940. Control visits were planned on day 7, day 28 (efficacy evaluation) and day 56 (tolerance evaluation). The main criterion was dry eye symptoms globally assessed by a visual analog scale (VAS). The non-inferiority limit for the between-group difference of VAS changes was 10 mm. RESULTS: In the population of 169 patients (87 patients for C974P, 82 for C940), C974P was at least as effective as C940 on symptoms (non-inferiority hypothesis confirmed). The mean VAS value fell by one third in the two groups. The objective signs improved identically in the two groups: corneal staining by fluorescein (p=0.96), rose Bengal score (p=0.73), and lacrimal break-up time (p=0.73). The dosage adaptation was slightly lower than three instillations per day (p=0.16). The adverse events were mild or moderate. CONCLUSION: C974P galenic changes are able to reach the same level of efficacy on dry eye symptoms and ocular surface damages as the conventional tube carbomer gels.

[Bilateral uveitis with definitive hypotony caused by systemic cidofovir]. / Uvéite bilatérale et hypotonie définitive due au cidofovir intraveineux. A propos d'un cas.

We report the case of a 52-year-old man with AIDS and CMV bilateral retinitis, treated first with ganciclovir (cymevan) and then with cidofovir. During the treatment, the patient complained of a sharp decrease in visual acuity. Cycloplegics and topical corticosteroids were given. Then cidofovir was stopped and replaced with intravenous Foscavir because of the clinical inefficacy. The anterior uveitis resolved but the ciliary secretion has not stopped after 12 months of follow-up. The patient presented +11 hypermetropia with a choroidal edema and bilateral cataract. This case is interesting for its permanent hypotony and bilateral uveitis. A literature search has brought out a rate of only 3% of chronic hypotony. We hypothesize bilateral iatrogenic ciliary body necrosis, as described in the animal models.

[Cost efficiency study of lacrimal canal obstruction treatment]. / Etude coût-efficacité du traitement de l'obstruction du canal lacrymal.

OBJECTIVE: To compare three methods used to clear the lacrimal canal. PATIENTS AND METHODS: A total of 32 files (20 for the dacryocysto-rhinostomy by endoscopic way, 5 for the dacryocysto-rhinostomy by external way and 7 cases of percutaneous stenting) were reviewed. For each, costs of performed interventions were reviewed. An average of the total cost per patient was calculated for all three methods and was then correlated to the initial efficiency of the method. RESULTS: Results show that the average cost for stenting is up to 1,366.80 EUR, for the endoscopic way is up to 2 001.53 EUR and for the external way is up to 2,220.46 EUR. ANOVA (Analysis of Variance) gives significant results when comparing stent to endoscopic way (p=0.000007) and to the external way (p =0.02). The analysis of sensitivity concerning the success rate of various treatments shows that the stent was potentially the most cost-effective and that a failure rate of 35.1% is rather acceptable by comparison to the endoscopic method. If the stent is considered as an outpatient intervention, then, a failure rate of 50% is acceptable. CONCLUSION: If the failure rate stays under 35.1%, the stent may be considered as a short-term cost-effective method.

[Idiopathic epiphoras in adults treated with lacrymal-nasal stents]. / Traitement des épiphoras idiopathiques de l'adulte par stent lacrymo-nasal.

Fluoroscopic nonsurgical placement of an expandable polyurethane stent is less invasive than surgery for the treatment of epiphora due to obstruction of the nasolacrimal duct. It needs to be performed with the collaboration of an ophthalmologist, using a high resolution digital subtraction imaging unit.

[Is there a delay in bathing the external eye in the treatment of ammonia eye burns? Comparison of two ophthalmic solutions: physiological serum and Diphotérine]. / Existe-t-il un délai pour le lavage oculaire externe dans le traitement d'une brûlure oculaire par l'ammoniaque? Comparaison de deux solutions de lavage: sérum physiologique et Diphotérine.

PURPOSE: An experimental animal study was conducted to analyze the delay for ocular bathing in the treatment of severe ocular ammonia burns. Two solutions of ocular wash, saline solution and Diphotérine were compared. MATERIAL: and methods: The study included 23 eyes of New Zealand albino rabbits that received for 1 minute 100 microl of 15.3% ammonium solution. Each eye was then washed with 250 of saline solution or 250ml Diphotérine after a delay of 1, 3, 5, 10 or 30 minutes. Effects were assessed on the basis of changes in anterior chamber pH, ammonia concentration in the anterior chamber, and cytopathology examination of the burned corneas. RESULTS: Ocular wash with Diphotérine in the first minutes following ocular burn induced an inflexion of the pH curve unlike ocular wash with saline solution. At 30 minutes, there was no inflexion of the pH curve and the ammonia concentration in the anterior chamber was low. Contrary to ocular wash using Diphotérine, stromal edema was seen at cytopathological analysis after washing with saline solution. CONCLUSIONS: This study provides evidence of the interest of ocular bathing in the first minutes following ocular burn by ammonia. The efficacy of external ocular washing with Diphotérine was proven by biochemical and cytopathological demonstrations. The importance of sequelae were related to the degree of initial stromal edema.

Comparison of intraocular treatment of DMTU and SOD following retinal ischemia in rats.

The effect of intravitreal injections of DMTU (dimethylthiourea) and SOD (superoxide dismutase), two free radical scavengers, was evaluated in a rat model of retinal ischemia induced by elevated intraocular pressure. The drugs were administered just before or just after a 60 min ischemia. At days 2 and 7 after reperfusion, retinal recovery was evaluated by electroretinography. At day 7, layer thicknesses and cell rows were measured from histologic sections of paraffin-embedded retinas. In the vehicle-treated control group, we observed a decrease in the inner retinal layers and b-wave amplitude impairment. SOD injection (6 units/eye) protected the retina from ischemia/reperfusion injury. At day 2 after reperfusion, electroretinographic recovery was more efficient when SOD was administered just after ischemia (99%) than after pretreatment with SOD (81%) (p<0.03). In the DMTU-treated group (75 microg/eye), only the pretreatment induced significant electrophysiologic (40%) (p<0.001) and morphologic recovery.

[Endonasal dacryocystorhinostomy using endoscopic guidance. Personal experience]. / Dacryocystorhinostomie endonasale sous guidage endoscopique. Notre expérience.

INTRODUCTION: Endonasal dacryocystorhinostomy (DCR) with endoscopic guidance is one of the therapeutic answers for low obstructions of the lacrimal system and is of renewed interest thanks to modern optical and surgical endoscopic means. MATERIAL AND METHOD: Nine DCRs were performed on patients aged from 27 to 86 years, with a dual ENT-Ophthalmologist team, using transillumination of the lacrimal sac and the fitting of a two-canal probe for 3 months. RESULTS: Only the first case operated was a failure. The average success for lacrimal irrigation was 89% with a follow up of 3 to 15 months (average 8 months). In one case owing to a dacryolith, it was extracted with the endonasal approach. CONCLUSION: Peroperative transillumination of the lacrimal sac is the best guide to performing the stomy. The two-canal probe kept for 3 months in the neo-ostium perhaps ensures correct mucous healing. The technique is safe, efficient and not very traumatic: it should be a technique of first intention, capable of replacing the cutaneous approach.

[Experimental study about intra-ocular penetration of ammonia]. / Etude expérimentale sur la pénétration intra-oculaire de l'ammoniaque.

PURPOSE: The seriousness of ocular alkali burn depends on low quick the alkali to enter the eye. We report the results of an experimental study on intra-ocular penetration of ammonia. MATERIALS AND METHODS: This study included 23 eyes of New Zealand albino rabbits, burned for 1 minute by 100 microl of a solution titrating 15.3% ammonia. An pH meter probe inserted into the anterior chamber measured pH every 5 seconds. Experiment were carried out within 1, 3, 5, 10 and 30 minutes. An anterior chamber puncture was performed at the end of experiments, after of 1, 3, 5, and 10 minutes, for measuring the ammonia concentration in the anterior chamber. RESULTS: PH increased 1 to 3 minutes after applying of ammonia on the cornea, until a maxima 10, 5 to 6 minutes later, followed by an exponential decrease. After 30 minutes, pH was still higher than physiological pH, and the ammonia concentration was low. The penetration-ratio of ammonia through cornea was about 11%. Measured pH differed from pH calculated from the concentration of ammonia. CONCLUSIONS: The difference between measured and calculated pH evidences chemical reactions. The two pH increases interspersed with a plateau prove the existence of 2 successive acido-basic chemical reactions between ammonia and 2 sorts of acid. Also, the density of protein uptake can be calculated from ammonia. This suggests an interesting avenue of research as protein density can be related in the eye with the pK of the base, and thus foresee the potential danger of a base to biological tissues.

Scanning electron microscopy after cryofracture of normal and ischemic rat retinas.

The authors described the use of scanning electron microscopy after cryofracture to analyze rat retinas after experimental ischemia-reperfusion sequence. In Sprague-Dawley albino rats, intraocular hypertony by cannulation of anterior chamber was performed for 1 h on one eye. The other eye served as control. After 48 h of reperfusion, retinas were dissected. They were frozen and fractured before ultrastructural analysis by a scanning electron microscope. In the ischemic eyes the thickness of the photoreceptors layer was reduced, through internal disorganization resulting in misalignment of rods. There was swelling of the outer segments, a loss of adhesion between segments and superficial necrosis. Scanning electron microscopy after cryofracture permitted an analysis of the external morphology of retinal cells and intercellular components, especially the outer layers.

Bilateral eyelid localisation of a lymphoplasmacytoid lymphoma.

Eyelid localisation of non-Hodgkin's lymphoma is rare, and even more so when it is bilateral. We report a 58 year-old man who presented with an eyelid localisation of lymphoplasmacytoid lymphoma. The initial treatment was chemotherapy with good improvement but the relapse lead us to give radiotherapy with no further relapse 20 months later. Radiotherapy is the current treatment of localised eyelid lymphomas with excellent results. The prognosis is related to the initial staging and the 10-year survival rate is close to 80%.

Experimental electroretinographic exploration of retinal ischemia: preventive use of free radical scavengers and anti-PAF agents.

Electroretinographic exploration is an effective approach to evaluate retinal function. In order to investigate physiopathological mechanisms and evaluate potentially protective therapies for retinal ischemia, we developed three experimental models: the first two on isolated retina, with ischemia induced by either stopping perfusion or clamping the ophthalmic artery, and the third, in vivo, with ischemia induced by ocular hypertonia. Since free radicals are implicated in the formation of post-ischemic lesions, we evaluated the protective effects of drugs known to be free radical scavengers and of an immunomediator antagonist, an anti-PAF (platelet activating factor) agent.

[Bilateral acute retinal necrosis in a patient with acquired immunodeficiency syndrome]. / Nécrose rétinienne aiguë bilatérale chez un patient atteint d'un syndrome d'immunodéficience acquise.

A case of bilateral progressive outer retinal necrosis occurred after herpes zoster ophthalmicus in a patient with acquired immunodeficiency syndrome. This case does not correspond to the classical picture of progressive outer retinal necrosis. The disease led to blindness despite intravenous therapy with acyclovir and foscarnet. PCR could not identify any virus in the aqueous humour, but VZV is evidenced in cerebrospinal fluid. Acute retinal necrosis is now clearly defined by the American Uveitis Society, which should allow to determine its incidence and risk factors. Herpes zoster usually precedes the acute outer retinal necrosis. The infectious theory (VZV, HSV, CMV) widely prevails over the immune theory. We prefer the virus genome identification in the aqueous humor or in the vitreous by PCR to confirm diagnosis rather than the specific antibody titration. Therapy consists in acyclovir, foscarnet and ganciclovir. But whatever the treatment, the visual prognosis is poor.

Antioxidant effect of a Ginkgo biloba extract (EGb 761) on the retina.

Several investigations have recently shown that the retina is very sensitive to oxygenated free radicals (O2-, OH.) at the origin of the membrane phospholipids peroxidation. Peroxy radical (ROO.) release is responsible for the induction of electrophysiological disturbances leading to retinopathy development. As Ginkgo biloba extract (EGb 761, IPSEN, France) was reported to scavenge primary (O2-, OH.) and secondary (ROO.) free radicals, we evaluated its antioxidant effect on retinas of albino rats submitted to different types of aggressors. On isolated rat retina, EGb 761 given orally significantly protected against lipoperoxidation induced by a mixture of ferrous sulfate and sodium ascorbate added to the perfusion solution. With EGb 761, the decrease of the b-wave ERG amplitude was less pronounced and the retina survival was increased. EGb 761 was also effective against ischaemia-reperfusion disorders due to occlusion of the central retinal artery or by intraocular hypertony. Like other antioxidants such as superoxide dismutase tested on these models, EGb 761 significantly attenuated, according to a dose-response effect, the free-radical injury. EGb 761 reduces the decrease of the b-wave amplitude, the oedema, necrosis and ion homeostasis disturbances. Xenobiotics are also responsible for the retinotoxicity partly due to free radicals and PAF release. We noted an EGb 761 dose-dependent protective effect against acute and chronic chloroquine toxicity to the retina. The deleterious effect of chloroquine was characterized by a delayed b-wave and an asymmetry of the signal with slow declining b-wave. After EGb 761 treatment, the ERG aspect was partially normal. In conclusion, EGb 761, by its general free-radical scavenger properties, is an antioxidant that inhibits or reduces the functional and morphological retina impairments observed after lipoperoxide release.

[Giant peripheral tear of the retinal pigmented epithelium]. / Déchirure géante et périphérique de l'épithélium pigmentaire rétinien.

The authors present a case of gigantic tear of the retinal pigmented epithelium. This tear was situated in the middle periphery and seems to have appeared spontaneously together with a carotid-cavernous fistula. The functional outcome was favorable. The authors deal with the various possible patho-physiological mechanisms.

Recent developments in medical therapy of POAG with beta blocking agents.

Since 1987, an entirely computerized open study has been developed in Pr Sole's Ophthalmology Department: the CLERTORE project (Clermont-Tonus-Research). It is a data bank including all the ophthalmic data of hypertensive patients, whether treated or untreated. Every six months, the patients included in the CLERTORE project undergo a clinical ophthalmic examination as well as an automated visual field examination (OCTOPUS 500), an examination of the optic disc (ONHA) and fluorophotometry (FLUOROTRON MASTER). To date, 92 patients have been included in the project. One hundred and eighty-three eyes are examined every six months with a maximal follow-up of 42 months. Because of the numerous criteria of the data base, it is too early to give any statistical results. With a close look at the evolution of the examinations of some of our cases, this preliminary work however allows us to make the three following remarks: In the hypertensive patients, a modification of the papillary pallor is observed without any change in the visual field, C/D ratio and fluorophotometry. The pallor is clearly modified when adrenaline eye drops are given to glaucomatous patients. There is a break of the iridic blood barrier in some hypertensive patients, whether treated or untreated.

[Fluorophotometry and corneal endothelium]. / Fluorophotométrie et endothélium cornéen.

The corneal endothelium plays a major part in corneal deturgence and hydratation by functioning as a barrier and a pump. Fluorophotometry enables assessment of this barrier function because of endothelial permeability to fluorescein. After a description of the technique of fluorophotometry, the authors show its interest in the understanding of endothelial physiopathology: during aging, in compensated or decompensated endothelial dystrophy, during lens and corneal surgery, in irido-corneal endothelial syndrome and in pharmacology.

[Aqueous humor flow measured by fluorophotometry. A comparative study of the effect of various beta-blocker eyedrops in patients with ocular hypertension]. / Débit de l'humeur aqueuse mesuré par fluorophotométrie. Etude comparative de l'effet de différents collyres bêta-bloquants chez des patients ayant une hypertonie oculaire.

A randomized double-blind study of aqueous humor flow and intraocular pressure measurements before and four hours after instillation of placebo and beta-blocker eyedrops, was carried out in 40 hypertensive patients. The treated and non-treated patients either did or didn't show an optic disc excavation and a visual field defect. Hypertensive patients with a previous tension treatment will stop therapy on a 3-week period up to an increase of their own ocular tension value greater than or equal to 3 mmHg. The intraocular pressure statistically decreased of 20.8% four hours after topical placebo, the aqueous humor flow remaining unchanged. In this study, timolol eyedrops induced a greater decrease of the aqueous humor flow (39%), followed equally by betaxolol (23.8%) and carteolol (20.42%). Timolol and betaxolol eyedrops equally induced a significant decrease of the intraocular pressure. There was no effect of carteolol on the intraocular pressure. The outflow facility was independent of the instilled beta-blocker eyedrop.