Successful management of dry eye disease with a new eye drop formulation combining hyaluronic acid, trehalose, and N-acetyl-aspartyl-glutamic acid (NAAGA).

PURPOSE: To assess the clinical efficacy and safety of T2769, a new preservative-free eye drop combining hyaluronic acid (HA), trehalose and N-acetyl-aspartyl-glutamic acid (NAAGA), in dry eye patients. PATIENTS AND METHODS: This was a multicenter, non-comparative, open-label study. After a run-in period with NaCl 0.9% solution, 62 patients with moderate-to-severe dry eye disease (DED) were included and treated with T2769, 3 to 6 times/day for 42 days. The primary efficacy endpoint was the change in global ocular symptomatology assessed on a visual analog scale between Day 1 (D1) and D42. Other efficacy endpoints included ocular surface disease index (OSDI), soothing sensation, individual dry eye symptoms, conjunctival hyperemia, global ocular staining, tear break-up time, Schirmer test, and global efficacy assessed by the investigator. Safety was assessed throughout the study. RESULTS: A marked reduction in ocular symptomatology was observed from D1 to D42 with a mean change of -55.9±23.1mm (P<0.001). This was accompanied by a mean change in OSDI score from baseline of -44.6±15.9 (P<0.001) and a substantial soothing sensation in 82.3% of patients. Clinically significant improvements were observed for all ocular symptoms (mainly burning/irritation, stinging/pain, feeling of ocular dryness, foreign body sensation, itching/pruritus). Conjunctival hyperemia significantly decreased in 96.8% of patients (56.5% displayed no conjunctival hyperemia at D42 versus 0% at baseline). All signs and symptoms improved by D14 and further improved at D42. Investigators assessed the ocular efficacy of T2769 as very satisfactory or satisfactory for 91.9% of patients at D42. T2769 was well tolerated, with no ocular adverse events and only a few ocular symptoms upon instillation. CONCLUSION: Management of moderate-to-severe DED patients with the new formulation T2769, combining NAAGA to HA and trehalose, led to rapid and significant improvements in dry eye signs and symptoms with good tolerability.

Outcomes of intermittent exotropia surgery.

PURPOSE: To study the epidemiological and clinical characteristics of intermittent exotropia and to describe our therapeutic choices as well as their results and prognostic factors. MATERIALS AND METHODS: This was a retrospective study including 57 cases of intermittent exotropia. All patients underwent a complete ophthalmological examination with a sensory-motor assessment. Surgery was performed by the same surgeon, and the vertical component was addressed surgically at the same time as the exotropia. Statistical analysis was performed using SPSS software version 21.0. RESULTS: Our patients were classified as basic exotropia in 46 cases (80.7%), divergence excess in eight cases (14.1%), and convergence insufficiency in three cases (5.2%). Amblyopia was found in 26% of cases. The preoperative maximum angle of deviation was 36.5DP±9.1DS and a vertical component was found in 16 patients (28%). The most common was V pattern (8 patients). The mean age at the time of surgery was 14.8 years old. After a single surgery, we obtained motor success in 78.9% of the patients. Three patients were re-operated, with an overall motor success of 84.2%. CONCLUSIONS: Motor and sensory success may be achieved in intermittent exotropia. Rigorous, early management is necessary, even if tropic episodes are still rare. The rate of early consultation among children is still low in our country; thus, a national strabismus screening program must be established to obtain the best results.

Outcomes of surgery in patients with sensory exotropia.

INTRODUCTION: Sensory exotropia is often due to profound amblyopia. Surgery essentially aims to improve aesthetic appearance and quality of life. Our goal was to discuss clinical features of sensory exotropia as well as surgical indications and outcomes. METHODS: Medical records of 43 patients who underwent sensory exotropia surgery were retrospectively reviewed. Each patient had an ophthalmological examination and a complete sensorimotor assessment. All surgeries were performed by the same surgeon. We studied the influence of certain prognostic factors on motility outcomes, such as age of onset of strabismus, gender, delay of surgical management, degree of amblyopia, angle of deviation, and amount of recession/resection. RESULTS: The mean follow-up was 2.3 years. All of our patients had severe amblyopia. An abnormal retinal correspondence with no fusion or stereopsis was noted in all subjects. The mean angle of deviation was 44.5 PD±12.4 SD preoperatively. The alignment success rate after a single procedure was 65.1%. Eight patients developed recurrent exotropia and were reoperated, with a final alignment success rate of 74.4%. CONCLUSIONS: Sensory exotropia is characterized by a large angle of deviation and an altered sensory status. The overall goal of surgery is to improve the patient's aesthetics and quality of life by treating the maximum angle of deviation. Surgical outcomes are often satisfactory for the patients, but certain complications may occur, such as diplopia, enopthalmos, and recurrences.

Central serous chorioretinopathy: Professional repercussions among agents of the internal security forces.

PURPOSE: To describe the relationship between central serous chorioretinopathy (CSCR) and stress in addition to the transient and permanent professional repercussions of this condition among security forces agents. MATERIAL AND METHODS: This is a retrospective, descriptive study of 22 CSCR patients. All patients were interviewed to establish their job status, a stressful triggering event, the number of consultations, absenteeism, the duration of episodes, the number of days off, exemption from certain activities and professional reclassification. All of our patients underwent a complete ophthalmological examination and ancillary testing (OCT optical coherence tomography, fluorescein retinal angiography) to establish the positive diagnosis and to determine the clinical form. RESULTS: During their daily activity, all patients were armed and worked night security duty. They all reported a stressful event just before the onset of the disease. The average visual acuity was 4/10 P6 all forms combined; with a visual acuity between 1 and 2/10 for the chronic form. Visual impairment was associated with absenteeism (mean length of time off was 1.13 months per episode), exemptions from carrying arms or night duty in 36.36% of cases, with professional reclassification in 22.7% of patients. CONCLUSION: CSCR affects psychology and alters the quality of life of patients who are generally young and professionally active. This can interfere with work performance and cause temporary or permanent disability.

Oculomotor palsy in diabetics.

INTRODUCTION: Oculomotor palsy is one of the most frequent neuro-ophthalmologic complications of diabetic patients. It generates less interest in the literature than the other ocular manifestations. Our goal was to study the clinical, epidemiological, therapeutic and prognostic characteristics of oculomotor palsy in the diabetic. METHODS: This is a retrospective study of 24 diabetic patients with oculomotor palsy. The ophthalmological examination emphasized ocular motility. We performed an orthoptic assessment and a Hess-Lancaster test. Neuro-imaging was ordered in case of IIIrd and IVth nerve involvement, bilateral involvement, multiple ocular cranial nerve palsy or associated optic neuropathy. Treatment consisted of glucose management and alternating monocular occlusion or prisms for the diplopia. Data were entered and analyzed on SPSS 11.5 software. RESULTS: The mean age of the patients was 58.5±11.9 years. Binocular diplopia was the main symptom. The oculomotor palsy involved the VIth nerve in 50% of cases and was bilateral in two cases. Three patients also had an optic neuropathy. The mean duration of diabetes was 11.7±11 years; poorly controlled diabetes was found in 75% of cases and an association with diabetic retinopathy was noted in 56% of cases. CONCLUSIONS: Long-standing uncontrolled type 2 diabetes, hypertension, coronary artery disease, left ventricular hypertrophy, and elevated hematocrit are the most common risk factors. The VIth nerve is commonly involved. Certain characteristics of the pupillary light reflex can help to differentiate an ischemic insult from an aneurysmal injury to the IIIrd nerve.

[Hypophysial macroadenoma revealed by clinical symptoms simulating chronic glaucoma]. / Macroadénome hypophysaire révélé par un tableau clinique simulant un glaucome chronique.

INTRODUCTION: A large optic cup is a sign of glaucoma, although it has been reported in other optic neuropathies, particularly in compressive neuropathies. CASE REPORT: A 37-year-old man presented with a decrease in visual acuity for 2 months. Fundus biomicroscopic examination revealed a glaucoma-like bilateral and asymmetric large optic cup. Neuroradiological examination revealed an expansive mass in the sella turcica that was compressing the optic tract. CONCLUSIONS: Optic nerve compression can lead to perimetric alterations and optic disc anomalies such as those seen in normal-tension glaucoma. Age under 50 years, visual loss, and neuroretinal rim pallor may lead to a suspicion of compressive neuropathy.

[Retinal venous occlusion in Behçet disease]. / Occlusions veineuses rétiniennes et maladie de Behçet.

PURPOSE: The aim of our study is to report three cases of retinal venous occlusion in patients with Behçet disease and to discuss the physiopathology of this vascular accident. METHODS: In this retrospective study, out of a series of 32 patients suffering from Behçet disease, we report three cases of retinal venous occlusion. General and ophthalmologic features are described. Treatment strategy is detailed for each case. RESULTS: There were 2 cases of branch retinal venous occlusion and one case of central retinal venous occlusion. Relapses and retinal neovascularization were the most common complications. CONCLUSION: The retinal venous occlusion in Behçet's disease is a non-common but severe complication. Early and appropriate treatment is required to improve the functional prognosis.

[Inflammatory pseudo-tumor of the lung. A pathology clinical study of one case]. / Les pseudo-tumeurs inflammatoires du poumon. Etude anatomo-clinique d'une observation.

Inflammatory pseudo-tumors of the lung are generally unifocal lesions with a benign prognosis. The pathogenesis is unknown. We report the case of a 71-year-old man who underwent exploration for dyspnea and chest pain associated with weight loss and a heterogeneous opacity in the lingula. This radiological and clinical presentation suggested a malignant bronchopulmonary tumor. Surgery was performed and the histologocial examination of the surgical specimen corrected the diagnosis: inflammatory pseudo tumor. No recurrence has been observed at three years.