Homoeopathic eye drops in the treatment of mild-to-moderate dry eye disease: Randomised, prospective, multicentre, single-masked study.

INTRODUCTION: To compare the efficacy and safety of a homeopathic eye drop medicinal product (Homeoptic®) with 0.9% sodium hydrochloride eye drops (Larmabak®) in patients with mild-to-moderate dry eye disease (DED). METHODS: Prospective, single-masked, observer-blinded, multicentre study on adult patients. Non-inferiority primary endpoint of the relative change between treatment groups in a composite Visual Analogue Scale (VAS) score covering five symptoms of DED, namely pain, itching, sensation of dry eye, impression of foreign body presence and burning, after 30 days of treatment. Details of all Adverse Events (AEs) were recorded and analysed. RESULTS: Ninety three patients were randomised to each treatment arm. At Day 30, the mean VAS symptom score was 26.0 ± 18.8 in the Homeoptic® group and 32.8 ± 21.2 Larmabak® group. Homeoptic® was demonstrated to be non-inferior to Larmabak®: the mean treatment difference of -7 being below the 10 mm upper limit of the 95% CI ([-12.9; -1.0]) pre-set as significant. The superiority of Homeoptic® over Larmabak® was then established with detection of a significant difference between the two treatment groups (p = 0.022). Significant differences between the treatment groups in favour of Homeoptic® were also detected in isolated VAS scores for the symptoms dry eye sensation (p = 0.009) and burning (p = 0.004). Results of ocular surface staining tests to estimate corneal and conjunctival damage as well as patient satisfaction were also significantly in favour of Homeoptic®. No new safety concerns were identified. CONCLUSION: Homeoptic® is more effective than Larmabak® at relieving the symptoms of DED and constitutes an effective treatment for mild-to-moderate DED.

[Subhyaloid hemorrhage following a Valsalva maneuver]. / Hémorragie rétrohyaloïdienne secondaire à une manoeuvre de Valsalva.

The authors present a case of a 48-year-old man complaining of a temporal nasal scotoma without visual impairment, occurring after sneezing. The perception of scotoma is explained by a retrohyaloidal hemorrhage sparing the optical axis. The hemorrhage, resulting from the break of two superior temporal veins, disappeared within 8 months without after effects. The authors explain the responsible mechanisms and analyze the different cases published in the literature.

[PET-scan in orbital Malt lymphoma and its value in diagnosis and management: a series of four cases]. / Diversité clinique du lymphome de Malt orbitaire et intérêt du PET-scan. A propos de quatre cas.

INTRODUCTION: The orbital location of mucosa associated lymphoid tissue (Malt) lymphoma (ML) is rare and can appear in very different forms. Biopsy is decisive for diagnosis. Although the positron emission tomography (PET) scan is rarely used in ophthalmology, it appears useful in our experience. We report four cases illustrating the diversity of the orbital localization in ML. Case 1 is a 41-year-old woman presenting unilateral corticosteroid-resistant dacryoadenitis. The PET-scan clearly fixed at the orbit. After anatomopathologic confirmation, a 36-Gy orbital radiotherapy was carried out, leading to the clinical and tomographic remission. CASE REPORTS: Case 2 is a 61-year-old patient, presenting a small cell carcinoma of the lung, initially referred for unilateral exophthalmia. MRI highlighted a bilateral orbital infiltration, with a hot spot on the PET-scan. The clinical suspicion of orbital metastasis was not confirmed: the biopsy concluded in ML. Case 3 is a 64-year-old woman, referred for unilateral and resistant conjunctival hyperemia. Clinical diagnosis was myositis of the superior rectus muscle. The PET-scan did not fix in the orbit but revealed a pleural location. The muscular biopsy concluded once again in ML. Case 4 is a 68-year-old woman who had a history of sinusal ML. Diplopia with a second orbital location, non specific in CT but fixed in PET, was found. The biopsy concluded in ML with transformation toward an aggressive lymphoma. CONCLUSION: Although the lacrimal gland location is well-known, unspecific orbital infiltration and orbital myositis are less common, which highlights the value of a non invasive exploration before biopsy. The advantages of the PET scan in orbital ML has not been sufficiently studied. In our experience, it was useful in these four cases. Orbital ML can take on different aspects that are sometimes misleading. PET is very useful in diagnosis before the biopsy, in therapeutic decisions, and in follow-up after treatment even if it does not always fix in the orbit.

[Assessment of risk factors for retinal vein occlusions in patients under 60 years of age]. / Evaluation du bilan étiologique des occlusions veineuses rétiniennes du sujet âgé de moins de 60 ans.

PURPOSE: To assess the biologic factors contributing to the risk for cardiovascular and coagulation problems in patients under 60 years of age with retinal vein occlusions (RVOs) in order to determine the advantages of an exhaustive etiologic search. PATIENTS AND METHOD: Observational and retrospective study on 43 patients under the age of 60, 30 of whom presented central or hemicentral retinal vein occlusions; 13 were affected with branch retinal vein occlusions. All patients received a systematic check-up including blood pressure measurement, blood cholesterol level, carotid Doppler imaging, intraocular pressure measurement and glaucoma history, presence of thrombophilic factors (protein C/S, activated protein C resistance, antiphospholipid antibodies), and presence of disturbed homocysteine metabolism. A systemic medical history was also taken. RESULTS: The most frequent factors associated with central retinal vein occlusion (CRVO) were hyperhomocysteinemia (33%), arterial hypertension (23%), hypercholesterolemia (20%), open-angle glaucoma or intraocular hypertension (13%), and diabetes (10%). As for branch retinal vein occlusion, the only notable risk factors were arterial hypertension and hypercholesterolemia (46.2% and 38.5%, respectively). DISCUSSION: and conclusion: Our results are consistent with etiologic data of RVO already reported in the literature. They further underline that there is little advantage to an exhaustive etiologic investigation to detect thrombophilia in the absence of a suggestive medical history. Finally, our data suggest the benefit of checking for hyperhomocysteinemia, frequently found in patients with CRVO, and easily correctable with a vitamin supplement.

[DRESS syndrome with bilateral panuveitis, elevated intraocular pressure, and HHV-6 reactivation: a case report]. / DRESS syndrome associé à une pan-uvéite bilatérale: à propos d'un cas.

INTRODUCTION: DRESS syndrome (drug rash or reaction with eosinophilia and systemic symptoms) is a rare but life-threatening drug hypersensitivity syndrome with a potential viral cofactor. The syndrome is characterized by rash, fever, hematological disorders (eosinophilia, lymphocytosis), and systemic symptoms (adenopathy, multiorgan involvement). CASE REPORT: We report the first description of acute bilateral panuveitis with elevated intraocular pressure associated with anticonvulsant-induced DRESS syndrome, hypogammaglobulinemia, and HHV-6 reactivation in a 63-year-old-woman. Complete general and ophthalmological recovery was obtained 4 weeks after the end of anticonvulsant drug exposure without corticosteroid prescription, with the patient remaining free of disease after 6 months. DISCUSSION: Our data suggest that uveitis may be one of multivisceral involvements described in drug hypersensitivity syndrome. The data also suggest that HHV-6 may play a role in the complex pathogenesis of DRESS as well as in the development of immune inflammatory disorders such as bilateral panuveitis with elevated intraocular pressure and alteration of retinal and choroidal circulation in this patient.