Microalbuminuria and markers of the atherosclerotic process: the D.E. S.I.R. study.

The relationship between microalbuminuria and tissue-type plasminogen activator antigen (tPA-ag) and fibrinogen was evaluated in non-diabetic subjects. Subjects were participants of the D.E.S.I. R. (Data from an Epidemiological Study on the Insulin Resistance syndrome) Study. Analyses were carried out on 2248 women and 2402 men for fibrinogen and on 272 women and 284 men for tPA-ag. Microalbuminuria was defined as urinary albumin concentration greater than 20 mg/l. Men with microalbuminuria had a 6% higher fibrinogen concentration than those without (3.07 g/l (95% confidence interval: 2.99,3.15) vs. 2.89 g/l (2.87,2.91), adjusted for age and smoking). This relationship existed in hypertensive as well as non-hypertensive subjects. The association between microalbuminuria and tPA-ag existed only in hypertensive men, those with microalbuminuria having a 21% higher tPA-ag than those without (4.39 ng/ml (3.70,5.08) vs. 3.63 ng/ml (3.32,3.94), adjusted for age and smoking). Adjustment for other risk markers for cardiovascular disease did not change the results. There was no relationship between microalbuminuria and these haemostatic factors in women. The results of this study suggest that in non-diabetic men, microalbuminuria is associated with fibrinogen, but with tPA-ag only when concomitant with hypertension.

In vitro evaluation of inflammatory cell response after CF4 plasma surface modification of poly(methyl methacrylate) intraocular lenses.

The inflammatory cell response of tetrafluorocarbon (CF4) plasma surface modification of poly(methyl methacrylate) intraocular lenses (IOLs) was investigated in vitro. After two hours of lens contact with human granulocytes, scanning electron microscopy showed significantly less cell activation and granulocyte adhesion on the surface-modified IOL than on the untreated IOL (P < .01). The x-ray photo-electron spectroscopy analysis of the CF4 plasma surface modification demonstrated that new compounds containing fluorine were homogeneously grafted onto the PMMA lens surface, resulting in a marked increase of contact angle. These in vitro results must be confirmed by in vivo studies of CF4 plasma surface modification of IOLs.

Regulation of optic nerve head blood flow in normal tension glaucoma patients.

PURPOSE: To investigate the regulation of the optic nerve blood flow (Fonh) in response to an increase of the perfusion pressure (PPm) in normal tension glaucoma (NTG) patients and in age-matched normal volunteers. METHODS: Measurements were performed in 16 eyes of NTG patients and in 10 eyes of age-matched controls. Laser Doppler flowmetry (LDF) was applied to calculate the relative flux of red blood cells at the temporal rim of the optic nerve head (ONH) in response to increases in PPm. PPm was raised through an increase in systemic blood pressure induced by isometric exercise. Before being tested, all patients had 3 weeks of washout of any local medication. RESULTS: In the NTG group, mean ophthalmic arterial blood pressure increased during isometric exercise from 73 to 89 mmHg (22%), resulting in a 29% increase of the PPm. This increase did not induce any significant change in mean Fonh. For the control group, the 28% increase of PPm also did not significantly affect Fonh. There was a trend for a greater increase in vascular resistance during isometric exercise in the NTG than in the normal control group (47% versus 25%). CONCLUSIONS: The LDF parameters, measured in the ONH, did not indicate an abnormal Fonh regulation in response to an increase of the PPm in either normal subjects or NTG patients. The maintenance of constant blood flow is achieved by an increase in local vascular resistance. Our data show a greater percent increase in vascular resistance in the NTG patients compared to the normal subjects for a similar percent increase in PPm in both groups during squatting. This suggests some alteration of the vessel tone regulatory mechanisms in NTG patients.

[Correlation between Goldmann and non-contact tonometry based on corneal thickness]. / Correlation entre tonometrie de Goldmann et tonometrie non-contact en fonction de l'epaisseur corneenne.

In this transversal study, we measure the intra ocular pressure by means of the Goldmann tonometer and a Non-Contact tonometer along with the central cornea thickness in 136 eyes of 73 patients. The statistical analysis of the collected data doesn't allow us to establish a correlation between the variation of the corneal thickness and the difference between the Goldmann tonometer and Non-Contact tonometer measures. The relative precision of the Non-Contact tonometer compared with the Goldmann tonometer doesn't seem influenced by the central cornea thickness.

[Arterial hypotension in glaucoma of normal or moderately high pressure]. / Hypotension artérielle dans le glaucome à pression normale ou modérément élevée.

BACKGROUND: Arterial hypotension, by decreasing blood flow in the optic nerve head, may be a risk factor for glaucomatous damage. The purpose of this study was to compare blood pressure in different types of glaucoma patients, using ambulatory recording. METHODS: An ambulatory blood pressure recording was performed in 55 glaucoma patients over a 24-hour period. Two groups of patients could have been differentiated according to pretreatment intra-ocular pressure level: a group of 38 patients (GPNM) with normal or moderately elevated intra-ocular pressure, and a group of 17 patients (GPH) with high intra-ocular pressure. RESULTS: A statistically significant different lower blood pressure was found in group GPNM for: diastolic mean blood pressure (76.4 versus 81.4 mmmHg p = 0.05), diastolic nocturnal (71.8 versus 78.1 mmHg p = 0.025), and for some hourly intervals: from 2:00 to 3:00 (p = 0.008), 8:00 to 9:00 (p = 0.01) and 15:00 to 18:00 (p = 0.03). The mean lowest readings were lower (p < 0.05) in group GPNM (95.8/54.4 versus 102/59.9 mmHg). The percentage of low readings (9.9% versus 5.1% p = 0.01) and systolic drops (0.226 versus 0.192 p = 0.018) were also higher in this group. CONCLUSION: Hypoperfusion of optic nerve head may be a significant factor in glaucomatous damage by compromising blood supply. It is important to identify arterial hypotension when examining of normal or moderately elevated pressure glaucoma patients, and ambulatory monitoring of blood pressure is currently the best test. These episodes should be taken into consideration, especially when initiating systemic antihypertensive therapy, in order to maintain, as well as possible, perfusion of the optic nerve head.

[Role of arterial blood pressure in the development of glaucomatous lesions]. / Rôle de la tension artérielle dans l'évolutivité des lésions glaucomateuses.

PURPOSE: In a significant number of glaucoma patients, progression of visual field loss occurs despite adequate intraocular pressure (IOP) control. Other factors, mainly vascular, seem to play a role in the pathogenesis of these glaucomas. The purpose of this study was to investigate the role of blood pressure (BP) as one of the vascular risk factors for progression of glaucomatous damage. METHODS: Eighty-three glaucoma patients were categorizated as to whether their visual field defect were stable or progressive in the face of clinically stable IOP; all patients were followed for at least two years. The mean systolic and diastolic BP were determined, using a 24-hour ambulatory recording device, during diurnal (6 am-10 pm) and nocturnal (10 pm-6 am) periods. For each patient, the nocturnal systolic and diastolic dips, and the BP variability (i.e. standart deviation, and percentage decrease from maximal to minimal readings) were determined. RESULTS: Forty-three patients had stable visual fields (25 females, 58.9 years old +/- 6.88; 18 males, 58.6 years old +/- 11), while 40 patients showed progressive visual field loss (23 females, 67.4 years old +/- 9.98; 17 males, 64.5 years old +/- 9.44). In the progressive group, women were older (p = 0.017), systolic (p = 0.0375) and diastolic (p = 0.0083) dips were greater, as also BP variability: systolic standard deviation was greater (p = 0.027) as percentage decrease from maximal systolic readings (p = 0.034). There were no difference for systolic, diastolic, diurnal or nocturnal mean BP in these two groups. CONCLUSIONS: The finding in this study suggests that age, decreased nocturnal BP and high BP variability may be additional risk factors for progression of glaucomatous field loss.

[Topical indomethacin before cataract surgery without implantation - Ineffectiveness of a single dose administration (author's transl)]. / Indométacine locale et chirurgie de la cataracte sans implantation, inefficacité d'une dose unique préalable.

This is a double blind study on the eventual effect a single dose administration of an indomethacin collyrium given prior to surgery of cataract without implantation. The goal is to decrease post-operative reactions. Twenty patients were treated with indomethacin and then operated. Twenty witnesses were operated without prior administration of the collyrium. The control parameters were the following: the cell tyndall of the anterior chamber, the protein tyndall of the anterior chamber and the intra-ocular pressure. The parameters were studied from the first to the fifth post-operative day and on the fourteenth day. In some cases, structures of the anterior segment were explored by means of prolonged fluoroangiography. The goal was to study the permeability of the blood aqueous barrier. No significant difference was found between the two groups for any of the studied parameters. The result shows the ineffectiveness of a single dose administration of indomethacin in reducing postoperative reactions that result from lens extraction.

[Data bank for analysis of the normal visual field using the 30/1 central program of the automated Humphrey perimeter]. / Une banque de données pour l'analyse du champ visuel normal avec le programme central 30/1 du périmètre automatisé de Humphrey.

Quantification is one of the most interesting improvements given by the automated perimetry. Such approach has, for instance, permitted the development by J. Flammer of quantification indices for JO program of Octopus. However, for working this concept needs quantitative data on normal visual field. Using an Humphrey automated perimeter and central threshold 30/1 program, we have gathered with the "quantification" program ley Thot Informatique, normal data on 178 visual field from 117 normal outpatients attending Ophthalmology Department of the Angers Hospital (58 females-59 males). Then, those data have been ranked by age, to obtain reference visual fields and corresponding standard-deviation fields. There is a decrease in visual sensitivity in the superior part of the 30 degrees field when compared to inferior. There is a decrease in visual sensitivity with ageing-about 1 dB by decade-more in the peripheral part of the 30 degrees field than in the central part. Standard deviation visual field is of considerable interest to valid pathologic visual field detects. There is an increase standard deviation for the peripheral part of the 30 degrees field. Finally, standard deviation is increased in elderly people as compared to younger.

[Tonometric course after trabeculectomy. Apropos of 105 cases at the Lomé UHC]. / Evolution tonométrique après trabéculectomie. A propos de 105 cas observés au CHU de Lomé.

BACKGROUND: This study has been conducted in order to assess tonometric changes after trabeculectomies without antimetabolites in primary open angle glaucoma. MATERIAL AND METHODS: One hundred and five eyes (105) in 64 patients with complicated open angle glaucoma with drug-resistant intraocular pressure or presenting disease progression were followed for 36 months. RESULTS: The mean intraocular pressure before surgery was 32.24 mmHg. Success rate (IOP < 21 MMhG without additional medical treatment) assessed with the Kaplan-Meier method was 64% at 12 months, 60% at 24 months and 56% at 36 months. CONCLUSION: In our experience, many factors including the cost of medical treatment are discussed before the surgery. Our success rate probability was average. Antimetabolites and medical additional treatment are needed for improvement.

[Correlation between cup disk ratios and changes in visual fields in Togolese patients]. / Corrélation entre excavation du disque optique et altération du champ visuel chez les patients togolais.

BACKGROUND: We have undertaken this study to analyze the correlations existing between Goldmann perimetry and cup disc ratios in Togolese patients less than 45 years old. METHODS: Male and female outpatients presenting with cup disc ratio of 0.4 or over underwent Goldmann perimetric examination. RESULTS: There were 120 patients, 60 males and 60 females. Goldmann perimetry was normal in 3% cases. The 62% remaining abnormal cases comprised central and paracentral defects, peripheral depression, nasal steps and tubular fields. These defects were variously correlated to the cup disc ratios. CONCLUSION: Goldmann perimetry is less used since the introduction of automated perimetry; however it is still helpful in our particular countries. Due to the various correlations between the cup disc ratios and Goldmann perimetric defects, we have to strengthen the follow-up of patients whose first manual perimetry seems to be normal.

[Routine monitoring of patients treated with synthetic antimalarials]. / Surveillance pratique des malades traités par anti-paludéens de synthèse.

Routine tests of visual acuity, and ocular fundus, angiography, and ERG examinations should be conducted regularly in patients receiving synthetic antimalarial drugs. Toxicity of these compounds is a current problem as 8 out of 81 patients being treated presented symptoms associated with ERG changes or macular lesions, and reduced visual acuity in some cases. There was a lack of correlation between ERG effects and the onset of macular disorders: one patient had marked macular changes and a normal ERG while another had a normal fundus and visual acuity but abolished ERG activity. Identical doses do not always produce the same effect and toxic symptoms have developed after a dosage ranging from 86 to 760 g. This suggests the existence of individual hypersensitivity.

[Surgical treatment of secondary glaucomas with extensive goniosynechias (author's transl)]. / Traitement chirurgical des glaucomes secondaires avec goniosynéchies étendues.

The authors propose to consider that the liberation of the ciliary body of Benedikt, combined or not with vitrectomy and/or with surgery of the exposed ciliary body and/or with reconstruction of the angle and/or with the treatment of secondary glaucomas with extensive goniosynechias. 30 eyes were operated according to these principles during a period of two years. They presented an angle closure glaucoma that was neglected, provoking a chronic state via the formation of a ring shaped goniosynechia (11 eyes), an aphakic secondary glaucoma (7 eyes), neo-vascular glaucoma (3 eyes), a malignant glaucoma (3 eyes), absolute glaucoma (4 eyes), or secondary glaucoma of diverse causes (2 eyes). A favourable result in the IOP control was obtained in 69% of the cases with only a minor number of complications (ciliary body hernia (5 eyes), cataract (2 eyes), choroid hematoma (1 eye). In the future, the number of undesirable results and complications should diminish as the knowledge of the principles that guide this new surgical approach of secondary glaucomas becomes better understood.

[Indomethacin and intra ocular implant (author's transl)]. / Indométacine et implant intra-oculaire. Efficacité d'un traitement prolongé.

The authors compare two series of I.O.L. The first group of patients was treated with oral indometacin: 75 mg per os during six weeks. The second group did not receive indometacin. Anterior segment fluorographic study proves the effectiveness of the therapy. Dye leakage is minimised with indometacin, prostaglandin synthesis is inhibited and decreases the rupture of the blood aqueous barrier.

[Is trabeculectomy without danger in case of threatened fixation?]. / La trabéculectomie est-elle sans danger en cas de menace sur le point de fixation?

PURPOSE: This study examined the impact of trabeculectomy on the central visual field in patients in which field loss threatens fixation. METHODS: Fifty eyes in 45 patients demonstrating a visual field loss threat to fixation underwent trabeculectomy. All patients underwent visual field assessment before and within two months of surgery, using both the 24-2 quantitative program on the Humphrey Field Analyser, and the macular program which measures the threshold sensitivity three times per 16 points distributed in the central 5 degrees centrally at 2 degrees intervals. For inclusion in the study, each eye had to show involvement of at least two contiguous points in the central macular program, with a decrease in sensitivity to 15 dB or less, in a quadrant corresponding to a well-defined visual field defect shown on program 24-2. RESULTS: The average post-operative follow-up was 7.1 months (+/- 5.52). Overall intraocular pressure reduction was 40%. Visual acuity decreased on an average of half line. None of the eyes showed loss of fixation. The average number of points with decreased sensitivity in the central 5 degrees (15 dB sensitivity or less) was 6.06 points (+/- 3.36) pre-operatively and 5.78 points (+/- 3.85) post-operatively (p = NS). Mean Defect (MD) was noted to decrease by 1 dB (p = 0.0295) whereas Corrected Pattern Standard Deviation (CPSD) and Foveal Sensitivity (FS) was essentially stable. CONCLUSION: Based on the study, it appears that trabeculectomy can be safely offered to patients for surgical reduction of intraocular pressure even in those cases where central fixation is threatened by loss of vision within the five degrees of fixation.

[Congenital ectropion of the iris epithelium and glaucoma]. / Ectropion congénital de l'épithélium irien et glaucome.

Two cases of unilateral ectropion uveae with ipsilateral juvenile glaucoma are reported including one with ipsilateral ptosis. This rare, non progressive anomaly, is characterized by the presence of iris pigment epithelium on the anterior surface of iris stroma, quite often associated with neurofibromatosis, ipsilateral ptosis or Rieger's syndrome. Congenital or juvenile glaucoma is almost systematically associated with the condition and must be evaluated and treated. Pathogeny of the anomaly has to be interpreted keeping in mind the concept of neurocristopathy, i.e. developmental anomalies of neural crest origin tissues.

[Scintigraphy of the lacrimal ducts. Value of the lateral incidence in postoperative period]. / Scintigraphie des voies lacrymales. Intérêt de l'incidence latérale en postopératoire.

Lacrimal scintillography, a simple, non traumatic, and physiological method, has been for a long time an useful exploration in the study excretory pathology. It allows an accurate diagnosis especially in the case of functional stenosis and, due to its ability to indicate the exact seat of obstruction, this technique is able to determine the surgical treatment required. This study underlines the contribution of lacrimal scintillography in the control of surgical anastomosis permeability, because of a modification in the initial technique: the use of scintillography in employing the lateral view rather than the front view, usually used, permits a better visualisation of the new surgically created excretory passage, particularly in the posterior area of nasal fossae.

[Hemoglobinopathies and retinopathies in Lomé UHC]. / Hémoglobinopathies et rétinopathies au CHU de Lomé.

BACKGROUND: There are few publications concerning retinal complications of hemoglobinopathies in our country. We studied recruited patients to evaluate these complications. MATERIAL AND METHODS: From October 1993 to August 1995, 66 patients were recruited among clinical hematology out patients; all of them underwent acetate electrophoretic diagnosis and fluorescein angiographic examination. RESULTS: The mean age of the patients was 26,92 years, ranging from 5 years to 50 years; the genotypic forms were 34 SC (51.51%), 15 SS (22.72%), 11 AC (16.66%), 2 AS (3.03%), 2 CC (3.03%), and 2 A2F (3.03%). Thirty eight patients (57.57%) had retinopathies. The majority were proliferative retinopathies in 55,26% cases and in 44,73% non proliferarive retinopathies. These retinopathies were essentially present with SC (26 cases for 34 SC, 76.47%), predominantly proliferative forms (21 cases for 26 SC, 80.76%). CONCLUSION: Retinal complications are common in Togolese sickle cell patients; clinical course usually leads to proliferations. Early screening could help improve prevention, including laser photocoagulation.

[Modifications in blood zinc and lead concentrations and ALA-dehydratase activity in optic neuropathy from alcohol and tobacco abuse]. / Modifications des concentrations sanguines du zinc, du plomb et de l'activité de l'ALA-dehydratase au cours des neuropathies optiques alcoolo-tabagiques.

Plasma red blood cell and total blood zinc levels were significantly decreased in 52 consecutives cases of bilateral, retrobulbar, axial optic neuropathy caused by chronic abuse of ordinary wine and/or beer and/or hard beverages and cigarette smoking principally in men in their forties [plasma zinc: 746 mg/l +/- 179 (n = 52), control 907 mg/l +/- 127; red blood cell zinc: 10,218 mg/l +/- 1,327 (n = 10), control 12,244 mg/l +/- 1,307; total blood zinc: 4,849 mg/l +/- 1,069 (n = 51), control 5,831 mg/l +/- 644]. In contrast, blood lead levels were increased in these cases - blood lead: 344 mg/l +/- 101 (n = 30), control 193 mg/l +/- 94. Activity of red blood cell delta-amino-levulinic acid dehydratase (ALA-dehydratase), a zinc dependent enzyme, was decreased [red blood cell ALA-dehydratase; 18,8 IU/l +/- 2,2 (n = 13), control 44,8 IU/l +/- 3,3]. Plasma magnesium was slightly decreased while serum copper was not significantly modified. Possible ophthalmological implication of these findings are discussed.

[Therapeutic affect of zinc sulfate on central scotoma due to optic neuropathy of alcohol and tobacco abuse]. / Effet thérapeutique du sulfate de zinc sur le scotome central des neuropathies optiques alcoolo-tabagiques.

The oral administration of 400 mg/day for one month of zinc sulphate, when compared with placebo, provoked normal plasma zinc level in treated patients, principally men in their forties, with bilateral, retrobulbar, axial, optic neuropathy related to excessive smoking and consumption of ordinary wine and/or beer and/or spirits. Treatment significantly improved visual capacity (measured with Friedmann analyser) of the central scotoma area (5 degrees).

[Color Doppler ultrasonography of short para-optic ciliary arteries in vascular glaucoma]. / Echo-Doppler couleur des artères ciliaires courtes para-optiques dans le glaucome vasculaire.

PURPOSE: To study color Doppler imaging in orbital vessels, especially para-optic short ciliary arteries, in patients with vascular glaucoma. PATIENTS AND METHODS: Twenty vascular normal or moderate elevated pressure glaucoma patients (6 with bilateral glaucoma, 9 with unilateral glaucoma et 5 with asymmetric glaucoma) underwent a color Doppler imaging (Accusson 128XP) in orbital arteries: common carotid, ophthalmic artery, central retinal artery, short para-optic ciliary arteries. Systolic and diastolic blood flow velocities were measured, and resistance index of Pourcelot and ratios between different parameters were calculated. RESULTS: In patients with unilateral glaucoma, ratios of systolic velocities between para-optic ciliary artery and common carotid, and ratio of Pourcelot index between para-optic ciliary artery and ophthalmic artery were increased in glaucomatous eyes. And Pourcelot index were statistically significant increased in all glaucomatous patients of the study compared with normal subjects. DISCUSSION AND CONCLUSION: Comparison of Pourcelot index and ratios between parameters makes color Doppler imaging more reliable, especially when analyse short para-optic ciliary arteries, which vascularize optic nerve. In these arteries Pourcelot index was increased in vascular glaucoma patients. Vascular risk factor should be taken into consideration in this form of glaucoma.