[Anatomical and functional outcomes of the "3+PRN" therapeutic protocol in the treatment of diabetic macular edema]. / Résultats anatomiques et fonctionnels du protocole thérapeutique « 3+PRN ¼ dans le traitement de l'œdème maculaire diabétique.

PURPOSE: To evaluate the anatomical and functional results of the "3+PRN" protocol in the treatment of diabetic macular edema (DME), determine the predictive factors for good final visual acuity, and compare it to other protocols. MATERIALS AND METHODS: We conducted a retrospective, descriptive, comparative, cross-sectional study of patients with DME, which we dubbed HTSM. All patients were treated with three monthly initial intravitreal injections (IVT) of 1.25mg bevacizumab and followed according to the pro re nata (PRN) protocol for a period of 3years. The protocol was based on a monthly monitoring schedule for the first 3months, then increasingly spaced out over time. "On-demand" treatment was indicated with resumption of bevacizumab IVT in the event of worsening of DME. RESULTS: A total of 52 patients were included. The mean age was 65years. Type 2 was the most frequently observed type of diabetes. The mean duration of the PRN protocol was 6months, and the mean number of injections was 6. The mean visual acuity (VA), initially 1/10, improved to 3/10 by the conclusion of the 3+PRN protocol, with an improvement of more than 5 letters in 77.6% of cases. The mean initial central macular thickness (CMT) was 451.5µm. The final mean EMC decreased to 298.5µm, which corresponds to a reduction of 153µm compared to the initial value. The mean subfoveal choroidal thickness, initially 304.2µm, decreased to a mean of 284.5µm at completion. Comparative analysis of the results before and after the PRN protocol confirmed the existence of a statistically significant correlation between VA and CMT (P<0.05). No correlation was observed between age and visual acuity or between initial and final VA. The analysis of the various tomographic parameters and VA revealed a significantly better visual improvement in the group in whom the external limiting membrane (MLE) and ellipsoid zone (ZE) were intact (P=0.04), as well as in the group in whom serous retinal detachment (SRD) was absent (P<0.001). Posterior vitreous detachment (PVD) was the most frequently observed vitreomacular anomaly. The final VA was similar in the groups with and without PVD (P=0.04). CONCLUSION: The 3+PRN protocol is effective both functionally and tomographically in the treatment of DME. Various tomographic parameters might influence therapeutic efficacy. However, further in-depth studies are needed to better investigate these parameters.

[Role of optical coherence tomography in unilateral amblyopia]. / Apport de la tomographie en cohérence optique dans l'amblyopie unilatérale.

PURPOSE: To compare the macular and papillary parameters on optical coherence tomography (OCT) between the amblyopic eye and the healthy eye in subjects with unilateral strabismic or anisometropic amblyopia. PATIENTS AND METHODS: This is a cross-sectional and comparative study carried out over two years, from April 1, 2019, to March 31, 2021. We included patients aged over 5years, followed for unilateral amblyopia, free of any neurological and/or ocular pathology. The evaluation of the macular and papillary parameters in the amblyopic and healthy eyes was performed with Swept-Source Optical Coherence Tomography (OCT-SS). The parameters were compared according to age group and type of amblyopia. RESULTS: We collected 50 patients, 29 children, and 21 adults, with a mean age of 19.8years. Amblyopia was secondary to anisometropia in 40 patients and strabismus in 10 patients. Analysis of macular tomographic parameters found no significant difference between amblyopic eyes and healthy eyes for mean macular thickness (P=0.86), central macular thickness (P=0.86), or mean macular volume (P=0.54). The mean retinal peripapillary fiber thickness (RNFL) was 107.48µm in the amblyopic eye and 103.8µm in the healthy eye, with a statistically significant difference (P<0.001). This significant thickening of the RNFL in amblyopic eyes was present in adults (P<0.001), children (P<0.001), anisometropic (P<0.001), and strabismic amblyopia (P=0.024). Analysis of the other optic nerve head parameters revealed no significant difference between amblyopic eyes and healthy eyes in terms of optic disc surface area (P=0.89), neuro-retinal annulus surface area (P=0.47), vertical (P=0.98) or horizontal (P=0.74) cup to disc ratio. CONCLUSION: Amblyopia is accompanied by thickening of the peripapillary retinal fibers without macular repercussions. However, larger prospective studies are needed to confirm these results.

Associations between inhaler technique and asthma control among asthma patients using pressurised MDIs and DPIs.

OBJECTIVES: To investigate associations between technique with pressurised metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs) used as controller medication and asthma control variables measured using Asthma Control Test (ACT) scores. DESIGN: In this cross-sectional study, the inhaler technique of asthma patients using pMDIs or DPIs (Turbuhaler® [TH] and Accuhaler Diskus™ [ACC]) were assessed against published inhaler technique checklists. ACT scores (maximum 25, higher score corresponding to better asthma control) were assessed. RESULTS: Of the 130 subjects enrolled in the study (41 TH, 54 ACC and 35 pMDI), inhaler technique scores (out of nine for all devices) were low for TH (4.4 ± 0.9) and ACC (5.4 ± 1.0) compared with pMDI (8.1 ± 0.9) (P < 0.001, one-way analysis of variance). Older age and use of pMDI were associated with better inhaler technique. ACT scores were low, consistent with very poorly controlled asthma (mean TH 13.1 ± SD 3.9, mean ACC 13.3 ± SD 3.9 and mean pMDI 12.8 ± SD 4.2). No significant association between inhaler technique scores and ACT scores was found. More recent asthma diagnosis and a higher level of education were associated with higher ACT scores (better asthma control). CONCLUSION: Asthma control was poor in this population. Lack of a significant association between the inhaler technique score and asthma control may reflect the multiple factors contributing to poor asthma control in the Jordanian population.

[Incidence and causes of visual impairment in the district of Mahdia, in east Tunisia: Retrospective study of 1487 cases]. / Incidence et causes de déficiences visuelles au Gouvernorat de Mahdia, à l'est de la Tunisie : étude rétrospective à propos de 1487 cas.

OBJECTIVE: To study socio-demographic characteristics and main causes related to visual impairment (VI) as a function of age bracket and to analyze their trends over time in the district of Mahdia. METHOD: A retrospective review was performed on 1487 cases of visual impairment registered with the social authorities in Mahdia, between 1980 and 2013. The social, demographic, vision exam findings and causes were ascertained and analyzed in an SPSS database. Incidence rates of VI and blindness due to various causes were calculated based on the demographic data from the NSI to estimate the time trends using the general linear regression model and Spearman correlation. RESULTS: Analyses included 1487 participants with a median age of 47 years, 40.6% of cases were aged under 45 years. Children accounted for 11.1% (165 patients), while age was between 16 and 45 years in 29.5% (439 patients), between 46 and 65 years in 31.5% (469 patients) and greater than 65 years in 27.8% (414 patients). The sex-ratio (M/F) was 1.78. Socially, 51% came from rural areas, 62% were illiterate, and 84% were unemployed. We observed blindness in 70% of participants and low vision in 30%. In children, the causes were dominated by congenital cataract and congenital glaucoma, each present in 31 children (18.8%). Between 16 and 45 years, glaucoma and hereditary dystrophies of the retina were found in 62 and 61 patients respectively (14% each). For age between 46 and 65 years, trachoma was responsible for 19.8% of cases of VI, glaucoma in 15.8% and cataract in 15.1%. Beyond 65 years, glaucoma accounted for 30.7% of the causes of VI and cataract 27.8% of cases. Trend analysis shows a significant increase in the incidence rate of visual impairment with an average of 12% per year (P=0.001). The mean age increased by 46% (P=0.003). Trachoma increased by 118% (P<0.0001) between 1980 and 1990, then declined by 42% (P=0.0013) between 1991 and 2013. Incidence of VI significantly increased by 4% for cataract (P=0.001), 23% (P=0.001) for glaucoma and 20% (P=0.02) for diabetic retinopathy, while VI related to refractive errors and AMD showed no significant change. CONCLUSION: Advanced age, lower educational and socio-economic status were associated with bilateral VI. Age related eye problems are the main causes of VI, and their incidence is tending to increase. Public health policies and procedures should be targeted to risk related populations and age-related diseases in order to control the incidence of visual impairment and avoid its consequences.

[Treatment of rhegmatogenous retinal detachment by pneumatic retinopexy: a review of 50 patients]. / Traitement du décollement de rétine rhegmatogène par rétinopexie pneumatique: étude à propos de 50 cas.

PURPOSE: : To evaluate the effectiveness and safety of pneumatic retinopexy as an alternative technique for rhegmatogenous retinal detachment repair. MATERIAL AND METHODS: We conducted a review of 50 patients (50 eyes) who had undergone pneumatic retinopexy as the initial procedure for rhegmatogenous retinal detachment between January 2001 and March 2006. The mean follow-up period was 22 months (range, 6-57 months). RESULTS: Pneumatic retinopexy resulted in reattachment in 35 eyes (70%) with one procedure. The final reattachment rate, after revision, was 94% (47/50 eyes). In seven eyes (14%), the cause of failure was the presence of missed or new retinal breaks. There was no correlation between the initial reattachment rate and the size of detachment, the status of the macula at presentation, the number of retinal breaks, and the type of retinopexy (cryotherapy or laser photocoagulation). A two-line or more improvement in Snellen acuity was achieved in 24 of 35 eyes (68.6%). A postoperative visual acuity equal to or better than 4/10 was significantly correlated with time from first symptom to presentation less than 1 month (p=0.05), preoperative visual acuity equal to or better than 4/10 (p=0.02), and attached macula at presentation (p=0.03). CONCLUSION: Pneumatic retinopexy appears to be an effective procedure for the initial management of primary rhegmatogenous retinal detachments with superior retinal breaks and without proliferative vitreoretinopathy.