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.

[Dupilumab-related blepharoconjunctivitis: Recommendations of the CEDRE group. Atopic dermatitis, conjunctivitis and dupilumab: Which management approach?] / Blépharo-conjonctivites sous dupilumab : recommandations du groupe CEDRE. Dermatite atopique, conjonctivites et dupilumab : quelle prise en charge ?

Dupilumab is a recombinant monoclonal IgG4 type antibody which inhibits IL4 and IL13 signaling. It is indicated in moderate to severe atopic dermatitis (AD) in adults and adolescents over 12 years of age. Its side effects include conjunctivitis and blepharoconjunctivitis, affecting between 4.7% and 28% of patients depending on the study. The incidence of conjunctivitis in patients treated with dupilumab for AD appears to be higher than placebo in clinical studies. This increase was not observed in patients treated with dupilumab for asthma or sinonasal polyposis. The risk factors for conjunctivitis in patients with AD are disease severity, pre-existence of conjunctivitis and low concentrations of dupilumab, but the pathophysiology of this disease is poorly understood. A literature search carried out in April and May 2020 showed an increase in the number of publications on the subject, but there are currently no official joint dermatologist-ophthalmologist recommendations for prevention and management. The objective of this article is to provide an overview of the status of this subject, to address the main questions raised by this type of conjunctivitis and to suggest a course of action for starting and continuing treatment with dupilumab in patients with AD, according to the recommendations of the French Ophthalmologist/Dermatologist group CEDRE.

[Management of ophthalmologic emergencies in general emergency departments: A retrospective multicenter study]. / Prise en charge des urgences ophtalmologiques en structure des urgences : étude multicentrique rétrospective.

INTRODUCTION: The growing shortage of working ophthalmologists makes it more difficult for the patient to access ophthalmological care, especially in an emergent context. These patients are thus taken to general emergency departments for ophthalmologic problems. OBJECTIVES: To observe the epidemiological characteristics of ophthalmic patients in general emergency centers and question the emergency physicians on their practice of ophthalmology. METHODS: A retrospective epidemiological study was conducted in the emergency departments of Rennes, Lorient and Saint-Brieuc over a period of three months. The demographic characteristics, diagnoses, examinations and procedures performed, opinions obtained from ophthalmologists and patient outcomes were studied. A qualitative study by online questionnaire was sent to the emergency physicians. RESULTS: Seven hundred and eighty-one patients were included, mainly men (68%) under 35 years (45%). The most frequent diagnosis was extra-ocular foreign body (32%). An ophthalmologist opinion was requested in 79% within 24hours. The online questionnaire was sent to 74 emergency physicians: 92% of them were willing to participate in additional training, 90% had sufficient means to practice ophthalmology in the emergency room. CONCLUSION: Emergency physicians could handle the most frequent ophthalmological emergencies, extra-ocular foreign bodies and minor trauma, with adapted material resources, autonomy for these conditions, and willingness for ophthalmologic training. Protocols could be proposed in order to optimize the care of these patients.

[Rapid improvement in visual function after high-dose oral corticosteroids in patients with inflammatory optic neuropathy]. / Amélioration rapide de la fonction visuelle après corticothérapie orale à forte dose chez des patients atteints de neuropathie optique inflammatoire.

PURPOSE: To study the progression of visual acuity and visual function parameters in patients with optic neuritis (ON) treated with high-dose oral corticosteroid therapy. METHODS: This retrospective descriptive monocentric study included nine patients with ON treated with orally administered methylprednisolone at 1000 mg per day for three to five days. The follow-up visits were performed on day 4 (D4), day 15 (D15), day 30 (D30) and day 90 (D90) after treatment was begun. The initial examination (D0) and the follow-up visits included a visual acuity (VA) assessment according to the Early Treatment Diabetic Retinopathy Study scale, a contrast sensitivity test and a 30.2 automated visual field (Visual Field Index [VFI]). The overall subjective tolerance of the treatment was assessed by patients on a scale from 0 to 10. RESULTS: We observed an improvement of all parameters from D4. From D0 to D4, the average VA increased from 40.1 letters to 57.9 letters, the average VFI from 40.9% to 70.3% and the overall average contrast sensitivity from 7.7 dB to 11.3 dB. From D15 to D90, the average VA increased from 77 letters to 80.3 letters, the average VFI from 91.2% to 97.9% and the overall average contrast sensitivity from 15.4 dB to 16.7 dB. Four patients rated tolerance at 10 (excellent), three between 8 and 9, and two at 6. CONCLUSION: We demonstrated rapid improvement of visual function parameters in patients with ON after high-dose oral corticosteroids.

Leucodystrophy and oculocutaneous albinism in a child with an 11q14 deletion.

We report a patient with an undetermined leucodystrophy associated with type 1A oculocutaneous albinism (OCA). Type 1 OCA results from recessive mutations in the tyrosinase gene (TYR) located in 11q14.3. The patient was found by FISH to carry a deletion of at least the first exon of the TYR gene on one chromosome and a (TG) deletion at codon 244/245 on the second chromosome. The existence of the microdeletion suggested that a gene responsible for leucodystrophy was located in the vicinity of the TYR gene. A combination of a test of hemizygosity and contig mapping studies allowed us to map the gene within a 0.6 cM region flanked by microsatellite markers D11S1780 and D11S931.

[Advantages and disadvantages of the femtosecond laser microkeratome]. / Avantages et inconvénients du microkératome laser femtoseconde.

Laser in situ keratomileusis (LASIK) complications are mainly attributable to imperfect cutting with the mechanical microkeratome. The femtosecond laser is an important challenger because it can provide extremely precise cutting beginning at any corneal point. We analyze the potential of this new tool from the results reported in the literature. The optomechanical control of the impact position provides freer and more effective intrastromal cutting than the blade. The best cutting matrix is obtained with the postage stamp method. If the plasma quality is not perfectly under control, side effects such as tissue streaks and secondary ultraviolet radiations can be observed. For LASIK surgery, femtolaser cutting can offer greater safety, reproducibility, predictability and flexibility. The risk of incomplete or irregular cutting and the free cap risk are reduced. Striae, epithelial defects and interface deposits should be minimized. A better flap congruence can limit the risk of secondary displacement and epithelial ingrowth. The results of making thinner flaps should be more predictable. Other than the high cost of the procedure, laser cutting has very few disadvantages. In 1999, Intralase Corporation introduced the first femtolaser microkeratome on the American market. Approximately 120,000 intra-LASIK procedures have been carried out with fewer cutting complications than with the mechanic blade.

[Tissular and mechanical effects observed with an experimental femtosecond laser microkeratome for corneal refractive surgery]. / Effets tissulaires et mécaniques observés lors de l'expérimentation d'un microkératome laser femtoseconde pour la chirurgie réfractive cornéenne.

PURPOSE: Despite progress in mechanical microkeratomes used in refractive surgery, mechanical complications during cutting of the cornea still occur. Cutting by laser could reduce these complications and to date, the femtosecond laser is the only potential candidate for this purpose. Our study reports preliminary results with a femtosecond microkeratome for cutting porcine corneas ex vivo. METHODS: We first examined the fundamental principles of the interaction between the femtosecond laser and the corneal stroma, including the volume of tissue lesions, the laser breakdown threshold of the stroma and the laser ablation selectivity. We then analyzed the quality of cutting corneal flaps with the laser, focusing on collateral tissue effects and the roughness of the interfaces observed both histologically and with scanning electron microscopy. RESULTS: The photoablative and photodisruptive effects were very similar with the femtosecond laser. This characteristic is specific to ultrashort impulsion photodisruptor lasers and allows for a very precise surgical procedure. The laser-induced breakdown threshold of porcine corneal stroma was found to be 0.55 J/cm2. Collateral tissue lesions were on the submicrometer level. The roughness of the stromal bed was optimal for postage stamp cutting, providing very many contiguous points of impact which were as spherical as possible. CONCLUSION: Corneal photodisruption with a femtosecond laser is reproducible and extremely accurate. The optomechanical parameters involved with this technique require great technological skill and should be placed in experienced hands.

[Clinical evaluation of the new screening procedures for hydroxychloroquine retinopathy, according to the American Academy of Ophthalmology guidelines. Prospective study of 184 patients]. / Évaluation en pratique clinique des nouvelles stratégies de dépistage des maculopathies toxiques au plaquénil, selon les nouvelles recommandations de l'American Academy of Ophthalmology. Étude prospective monocentrique à propos de 184 patients.

PURPOSE: To compare the results, in clinical practice, of screening procedures for hydoxychloroquine retinopathy, according to the new recommendations of the American Academy of Ophthalmology of 2011. METHODS: Hundred and eighty-four patients on long-term hydroxychloroquine underwent ophthalmologic evaluation, including fundus examination, 10.2 automated visual field, fundus autofluorescence, SD-OCT optical coherence tomography, and multifocal ERG, whenever possible, in a prospective monocentric study. RESULTS: There was a significant correlation (P<0.05) between cumulative HCQ dose and positive results on SD-OCT and 10.2 visual field. There were no significant correlations between high cumulative HCQ dose and positive results for fundus examination, autofluorescence, or multifocal ERG. Average cumulative doses between the healthy group (946g) and the maculopathy group (1427g) were significantly different (P<0.05). Out of 184 patients, 12 toxic maculopathies were found (prevalence 6.5%). For these 12 cases, 5 were diagnosed at clinical stages, and 7 were diagnosed in the early preclinical stage. Ten patients had positive visual fields, and 8 patients had pathological SD-OCT signs. Autofluorescence was affected in the clinical stage, but not in the preclinical stage. In four out of the twelve cases of maculopathy, patients had pathological ERG results. CONCLUSION: The significant correlation between cumulative HCQ dose, considered as the main risk factor for maculopathy, and positive SD-OCT and 10.2 visual field results render the combination of these two tests the basis of the screening strategy for plaquenil maculopathy. These results suggest using a simplified screening procedure, including annual SD-OCT and 10.2 visual field while taking the cumulative dose into account. Multifocal ERG seems more helpful for diagnostic confirmation than screening, especially for the preclinical stage. Fundus autofluorescence is not an efficient test for early diagnosis.

[Role of PET-scan in the positive diagnosis of sarcoidosis in the work-up of uveitis]. / Apport du TEP-scan dans le diagnostic positif de la sarcoïdose, au cours du bilan d'uvéite indéterminée.

INTRODUCTION: Sarcoidosis is a multisystem granulomatous inflammatory disease, which may present as uveitis. Work-up includes the search for pulmonary and extra-pulmonary sites, with the assistance of PET-scanning. MATERIAL AND METHODS: We present six patients enrolled retrospectively from March 2012 to November 2013 with uveitis, for whom a systemic work-up was performed, along with specific tests for sarcoidosis. 18-FDG PET-scan was performed when histology was inconclusive for epithelioid granulomata and giant cells, or when CT and/or chest X-ray were normal, in cases of uveitis clinically suggestive of sarcoidosis. RESULTS: Hypermetabolic foci were found in all patients, in inflammatory areas with foci mainly located in the mediastinal (65%), hilar (33%), cervical, and supraclavicular regions. There was no correlation between ACE levels and positivity of the PET-scan, since only two patients exhibited ACE > 70 IU/L. DISCUSSION: PET-scan is a promising technique in the field of sarcoid uveitis; however, histologic proof remains the gold standard. CONCLUSION: This study demonstrates the value of PET-scan in the assessment of indeterminate uveitis, by screening for sarcoidosis, and permits an assessment of the extent of the disease.

Randomised double masked trial comparing the efficacy and tolerance of 0.05% mequitazine eye drops versus 0.05% levocabastine and placebo in allergic conjunctivitis induced by a conjunctival provocation test with Dermatophagoides pteronyssinus.

AIM: A double masked randomised trial comparing 0.05% mequitazine eye drops with 0.05% levocabastine and placebo was carried out in otherwise healthy volunteers allergic to house dust mites (Dermatophagoides pteronyssinus). METHOD: Double masked, randomised, single centre study, comparing three parallel treatment groups. 60 healthy adults with a confirmed history of allergic conjunctivitis to house dust mites for at least 2 years were included and completed the trial. Conjunctival provocation tests (CPT) were done at screening, at visit 2 (V2) (1 week later), and at visit 3 (V3) (2 weeks after V2). Treatment was instilled in the same eye, 5 minutes after the CPT at V2, and twice daily until V3. CPT were scored 5, 10, 15, and 60 minutes after instillation of the dose of Dermatophagoides pteronyssinus antigen determined at inclusion (V2, curative test) or resulting in positivity (V3, preventive test) RESULTS: In the V2 (curative) test the difference between the active treatments and placebo on the redness+itching scores was not significant. At the V3 (preventive) CPT there was a lower number of reactions at the threshold dose with mequitazine (20%) compared to placebo (60%, p = 0.01) or levocabastine (45%, p = 0.10). CONCLUSION: This trial failed to clearly demonstrate curative superiority of topical antihistamines with placebo, when a single dose of treatment was instilled following CPT. However mequitazine 0.05% eye drops were superior to placebo in preventing a reaction to CPT, after 2 weeks of treatment.

Corneal myxoma associated with keratoconus and Down's syndrome.

PURPOSE: Primary myxoma of the cornea is extremely rare. Until now, only four primary corneal myxomas were reported in the literature, whereas secondary involvement of the cornea by conjunctival and limbal tumors is much more common. METHODS: We report an additional case in a 26-year-old woman with keratoconus and Down's syndrome. Excision of the corneal mass was performed by penetrating keratoplasty. Histochemical, immunohistochemistry, and ultrastructural studies were used to obtain a definitive diagnosis. RESULTS: The tumor exhibited the characteristic histologic features of myxoma. The tumor cells showed immunoreactivity for vimentin but not for S-100 protein, epithelial membrane antigen, CAM 5.2, HHF-35, or muscle-specific actin. Ultrastructural features were fibroblast-like or stellate cells with cytoplasm containing abundant, rough reticulum and dilated cisternae. No recurrence was observed 36 months after penetrating keratoplasty. CONCLUSION: This is only the fifth report of such an occurrence. Although the coexistence of myxoma in Down's syndrome with keratoconus is described here for the first time, the differential diagnosis of apparently evident acute hydrops on clinical inspection should not rule out the possibility of a corneal myxoma. Histologic analysis should therefore be performed.

[Myelinated retinal nerve fibers. Review of the literature]. / Les fibres à myéline rétiniennes. Revue de la littérature à propos d'un cas.

We describe the clinical findings and diagnostic particularities of myelinated retinal nerve fibers observed in a personal case and review the literature. An 8-year-old child was referred for bilateral papillary abnormalities. The diagnosis was myelinated retinal nerve fibers as white striated patches with feathery edges. Myelinated retinal nerve fibers are a developmental anomaly which may be continuous or discontinuous with the optic nerve head. They are reported to occur in 0.57% to 0.98% of ophthalmic patients. The pathogenesis has not been established. Myelinated retinal nerve fibers are clinically conspicuous. Although they are generally believed to be benign lesions, they occasionally are associated with ocular complications such as myopia.

[Diffuse diabetic macular edema and vitreoretinal interface pathology: a study of seven cases (ten eyes)]. / CEdème maculaire diffus de la rétinopathie diabétique et pathologie de l'interface vitréo-rétinienne.

PURPOSE: Diffuse diabetic macular edema (DDME) is a serious complication, only partially understood. In this study, we have attempted to find a relation between DDME and a pathologic vitreo-retinal interface (VRI). PATIENTS: We examined ten eyes using biomicroscopy, fluorescein angiography, B mode echography and for five of these eyes, OCT. We found that DDME and pathological VRI are indeed associated. DISCUSSION: We hypothesize that structural and biochemical changes of the vitreoretinal interface are closely related to the progression of DDME. We support this hypothesis with anatomical, epidemiological, physiopathological, clinical and paraclinical arguments. CONCLUSION: Diffuse diabetic macular edema appears to be mediated by vitreomacular traction caused by structural and biochemical changes of the vitreoretinal interface. The pathological inner limiting membrane (ILM) seems to be a risk factor in DDME development. During pars plano vitrectomy, the additional peeling of the ILM could improve the resolution of the macular edema.

[Outcome of a corneal graft with antecedents of radial keratotomy]. / Devenir d'un greffon cornéen aux antécédents de kératotomie radiaire.

We performed a penetrating keratoplasty with a donor corneal graft who had been operated by radial keratotomy one year ago. The clinical and endothelial cell density follow-up was 18 months. The endothelial cell loss was comparable to that of a non-operated donor graft. No complications such as reopening or vascular invasion of the incisions occurred. The authors conclude that radial keratotomy is not a contraindication for transplantation and suggest the use of such grafts for eyes with bullous keratopathy with a poor functional prognosis.

[Conjunctival provocation test with Dermatophagoides pteronyssinus in the diagnosis of allergic conjunctivitis from house mites]. / Test de provocation conjonctival au Dermatophagoïdes pteronyssinus dans le diagnostic des conjonctivites allergiques aux acariens domestiques.

INTRODUCTION: Perennial conjunctivitis due to house dust mites is the most frequent form of allergic conjunctivitis in urban environments. However, its diagnosis remains difficult for ophthalmologists. In this study, we evaluated a conjunctival provocation test (CPT) using standardized extracts of Dermatophagoides pteronyssinus (Dpt) and compared it to the diagnostic methods commonly performed in allergology: prick tests with dust and house dust mites and specific and IgE assay. MATERIALS AND METHODS: We performed a CPT on 60 volunteer patients, between the ages of 8 and 64 years, corresponding to 30 patients sensitized to house dust mites with the presence of specific IgE and chronic conjunctivitis, 21 patients not sensitized to house dust mites but presenting features of chronic conjunctivitis, and 9 asymptomatic patients. A house dust mite desensitizing treatment was not an exclusion criterion for a number of allergic patients. CPTs were prepared from Dpt allergenic extracts (Laboratoires Stallergènes, Antony, France) with 5 progressive concentrations by dilution in a nonphenolic physiological solution: 1.2 RI, 3.7 RI, 11 RI, 33 RI, and 100 RI. CPTs were performed in only one eye and asymmetry of the ocular response was evaluated by the cumulative clinical score of Abelson Chambers and Smith. The correlation between the 2 diagnostic tests was established by calculating the Cohen correlation coefficient or kappa. We also evaluated the sensitivity and diagnostic specificity for each test. RESULTS: The statistical correlation between specific IgE and the other allergological tests in for allergic conjunctivitis to house dust mites was 0.93 for the CPT, 0.46 for the prick test to Dpt, and 0.33 for the prick test to dust. The diagnostic sensitivities and specificities for each test were 90% and 100% for the CPT, 60% and 70% for the prick test to dust, 70% and 76% for prick test to Dpt, respectively. Beyond an antigenic cut-off value of 11 RI, we also observed greater hypersensitivity reactions for patients with lacrimal IgE or elevated specific IgE levels. CONCLUSION: The results obtained with the CPT confirm its high antigenic quality. It is a particularly useful, rapid, and perfectly safe clinical test. It is the only test able to establish a relationship between ocular manifestations and specific I(8)E.

[Floppy eyelid syndrome. Apropos of 4 cases and review of the literature]. / "Floppy eyelid syndrome". A propos de 4 cas et revue de la littérature.

Often unrecognized, Floppy eyelid syndrome is an impairment of the eyelid statics with marked conjunctival signs. Over-weight middle aged men are principally concerned. Excessive eyelid laxity in the Floppy eyelid syndrome is responsible for a night ectropion of the upper lid, creating the clinical manifestations. We report four cases of Floppy eyelid syndrome to illustrate our work and discuss the clinical and therapeutic aspects.

[Results of therapeutic photo-keratectomy using the Excimer laser. Apropos of 12 cases]. / Résultats de la photokératectomie thérapeutique par laser Excimer. A propos de 12 cas.

We report a series of 12 eyes which underwent phototherapeutic keratectomy with the Excimer laser Aesculap Meditec (model Mel 60). Mean follow up was 11 months (range 3 to 19 months). Six types of corneal pathologic lesions were treated: recurrent corneal erosions, corneal scars after herpetic keratitis, anterior stromal dystrophy, band keratopathy, mucous plaque, and scar after viral infection. Epithelium healed within the first post-operative week in 83.3% of cases. The goal of treatment was achieved in 75% of cases (100% of therapeutic success for recurrent corneal erosions and 66.6% for superficial corneal opacities). The main undesirable effects were postoperative pain, delayed reepithelialization (16.6%). One patient (8.3%) lost more than two lines of visual acuity. The results, the limits and the undesirable effects of phototherapeutic keratectomy are discussed from our experience and data found in the literature.

[Vitreous hemorrhage and pre-retinal hemorrhage "without obvious point of origin" in diabetic patients. Apropos of 5 cases]. / Hémorragie vitréenne et hémorragie prérétinienne "sans site d'origine évident" chez le diabétique. A propos de 5 cas.

Five diabetic patients with nonproliferative retinopathy or controlled retinopathy after photocoagulation developed intravitreous or preretinal hemorrhages of unknown origin. Intravitreous hemorrhage of unknown origin is characterized by the absence of angiographic hyperfluorescence suggestive of neovascularization. Examination of the retinal periphery with a three mirror lens reveals the absence of tears and an normally appearing arteriovenous network with no sign of bleeding. The clinical cases reported here demonstrated: 1) the significance of posterior vitreous detachment in the genesis of hemorrhage, 2) the difficulty encountered in assessing the seriousness of the hemorrhage and providing optimal treatment, 3) the importance of initiating treatment early.

[Hereditary retinal macrovessel. Report of 2 cases]. / Macro-vaisseau rétinien congénital. A propos de 2 cas.

PURPOSE: We report two cases of hereditary retinal macrovessel an uncommon condition where an anomalous retinal vessel crosses the macula. CASE REPORT: A 45-year-old woman complained of fluctuating visual acuity in the right eye for 10 years. A 24-year-old man was seen at a routine ophthalmic examination. In both patients, dilated fundus examination and fluorescein angiogram confirmed the diagnosis. DISCUSSION: Hereditary retinal macrovessel is a rare condition. The anomalous vessel is remarkably stable and complications only occur exceptionally as described in the literature.