Combined indomethacin/gentamicin eyedrops to reduce pain after traumatic corneal abrasion.

PURPOSE: To evaluate the analgesic action of combined indomethacin 0.1%/gentamicin eyedrops in traumatic corneal abrasion. METHODS: We evaluated 123 patients presenting traumatic corneal abrasion in a multicentre, randomised, double-masked study comparing two parallel treatment groups: indomethacin/gentamicin (group 1) or gentamicin alone (group 2). Study treatments were administered four times daily for 5-6 days. Pain (visual analogue scale), associated symptoms and safety were assessed. RESULTS: Starting from a comparable level, pain was reduced by 30% in group 1 and 15% in group 2, one hour after the first instillation, and by 59% and 42% respectively after the second. The global difference in pain relief from day 0 to day 4/5 was significantly better in group 1 (p = 0.015). Associated ophthalmic symptoms showed a greater decrease in group 1 after the first instillation (p = 0.007). Both treatments were well tolerated. CONCLUSIONS: Combined indomethacin/gentamicin eyedrops were effective and well tolerated in reducing the pain and discomfort associated with traumatic corneal abrasion.

[Plea for a graft]. / Plaidoyer pour un greffon.

With the promulgation of the "Bioethics" laws in 1994 in France, the Etablissement français des Greffes was endowed with the task of defining the principles controlling human tissue grafts in France. These laws require a precise control of all material and human input involved in each step of the grafting process. Organ removal from human cadavers by the ophthalmologist, graft preservation, validation of organ banks and recipient grafting by the surgeon are some of the many steps which must follow precise rules of good practices. All those who participate in these activities from organ removal to recipient grafting must comply with these rules to obtain the necessary administrative authorization. As the "Bioethics" laws will be re-evaluated in 1999, now is the time to propose possible alternatives aimed at increasing organ procurement and shortening patient waiting lists.

[Ocular cysticercosis]. / La cysticercose oculaire.

Ocular cysticercosis results from development of Taenia solium larvae, Cysticercus cellulosae, in the eye. This condition is observed all over the world but is particularly common in developing countries. The eye, like nervous system and muscle tissue, is a prime location for parasitic development because of its rich vascularization. Intraorbital cysticercosis accounts for 75 to 85% of cases and if untreated leads to blindness. Intravitreal involvement is the most common followed by subretinal involvement. Involvement of other structures such as the camera aqueosa, iris, and crystalline lens is rare. Diagnosis of intraocular cysticercosis is straightforward when cysticerci are visible. Immunologic testing of aqueous humor using ELISA, western-blot, or immunodetection of circulating antigens can be useful diagnostic techniques in patients with opacification of the eye. Involvement of the orbit, palpebra, conjunctiva, and lacrimal glands is observed in 20 to 25% of cases. Diagnosis of adnexal involvement is facilitated by ultrasonography and CT-scan. Drug therapy for ocular manifestations of cysticercosis is ineffective and hastens progression of the disease by exacerbating the inflammatory response. Surgical treatment is the only alternative. Significant progress has been made thanks to new microsurgical vitreal and retinal procedures but these techniques are often unavailable in developing countries. The severity of ocular cysticercosis and poor management facilities in developing countries underlines the need for prevention by sanitary measures and health education.

[Xerophthalmia: current data]. / La xérophtalmie: données actuelles.

Xerophthalmia is a term covering a range of ophthalmologic manifestations due to vitamin A deficiency. This condition occurs in preschool children in tropical regions affected by protein-caloric malnutrition. Clinical manifestations of the disease have been summarized in the 1974 five-grade WHO classification. Clinical diagnosis was traditionally made using a slit lamp to detect the pathognomonic manifestations and consequences of corneal and conjunctival xerosis. Currently diagnosis is greatly facilitated by determination of plasma levels using a micromethod, especially the relative dose response (RDR) test, and by conjunctival impression cytology (CIC). CIC is a simple and reliable method which allows mass screening and thus more effective evaluation of the impact of xerophthalmia on public health in Africa. The relationship between xerophthalmia and measles is complex. Vitamin A deficiency promotes measles which can in turn hasten perforation of keratomalacia especially in undernourished children. Vitamin A has a beneficial effect on both xerophthamia and measles. Curative and prophylactic administration of vitamin A at doses recommended by the W.H.O. considerably reduces not only xerophthalmia-related morbidity but also child mortality in tropical areas.

[Unusual case of bilateral optic neuritis in Lyme neuroborreliosis]. / Un cas rare de névrite optique bilatérale dans une neuroborréliose de Lyme.

The most common manifestations of Lyme disease are neurologic and rheumatologic, but ophthalmologic lesions can also occur and may even be dominant. The authors describe a case of bilateral optic neuropathy associated with Lyme borreliosis that quickly led to near-total blindness. In addition to a loss in visual acuity and field bilateral papillary edema was documented by angiofluorography. A spectacular improvement was obtained under combined antimicrobial therapy using doxycycline and corticosteroid therapy. The patient rapidly recovered full vision. These observations are discussed within the context of Lyme disease with a review of other relevant ophthalmologic complications. The importance of careful interpretation of serology is emphasized.

[Harada's disease. Report of a case]. / La maladie de Harada. A propos d'un cas.

Harada's disease is a uveo-meningitis syndrome characterized by meningo-encephalic manifestations preceded by bilateral posterior uveal lesions. The etiology of Harada's disease is still unclear but it probably involves an auto-immune reaction to melanocytes. This mechanism would account for the high incidence of Harada's disease in dark-skinned patients. This report describes a case of Harada's disease that occurred in a 28-year-old woman from North Africa. Ophthalmologic manifestations were typical with regard to clinical features and course involving bilateral papillary edema followed by exsudative detachment of the retina and diffuse cicatricial epitheliopathy of the posterior poles. However neurologic signs were mild, the main finding being atypical headache, and this particularity delayed diagnosis. Limited cerebral involvement that did not coincide with ocular lesions explains the fact that a thorough search for posterior uveal involvement with the aforesaid features was necessary. Although it occurs mainly in dark-skinned Asians, Harada's disease deserves the attention of physicians practicing in tropical areas.

[Keratoplasty à chaud: preliminary study]. / Kératoplasties à chaud: étude préliminaire.

The purpose of this paper is to review causes and follow up of 16 patients who have had a keratoplasty "à chaud" for corneal ulceration, perforation, or reviving chronically abscess, with a 9 years follow-up for a first group, and 8 months for the second. In 58%, the graft remained clear, and in 16%, the acuity was 4 to 6/10 degrees. Keratoplasty "à chaud" seems to be the most efficient method for treatment of inflammation, the most radical to restore the integrity of the eye, and can give oftentimes an accurate optical result.

[The cataract in Bangladesh. Epidemiology--treatment]. / La cataracte au Bangladesh. Epidémiologie--traitement.

The Bangladesh, earth of mud and water, is one of the most poor countries in the world. And it is a fact that the very special geographical, climatical and vital statistics are the victims of certain endemic diseases. For the most part, the diarrheoïcal diseases are prevailing. From the ophthalmologic point of view, avitaminosis A is the major risk factor during the childhood. However, as in many other countries, the prime cause of blindness is the cataract. This disease is surgically curable. The treatment is affected by the lack of surgeons and the big number of cases. An example of therapeutic strategy is presented by B.N.S.B.: Bangladesh National Society for the Blind.