House-dust mite sublingual-swallow immunotherapy in perennial conjunctivitis: a double-blind, placebo-controlled study.

BACKGROUND: The safety and the efficacy of sublingual-swallow immunotherapy (SLIT) in perennial conjunctivitis caused by house dust mite were evaluated in a double-blind, placebo-controlled study including 60 patients for 24 months. METHODS: Patients received either placebo or SLIT with standardized Dermatophagoides pteronyssinus (D.pt.) and D. farinae (D.f.) 50/50 extract. The evaluation of the efficacy of the SLIT was obtained by using standardized D. pteronyssinus (D.pt.) extracts on the antigen-specific conjunctival provocation test (CPT). Specific CPT, skin sensitivity and serum-specific IgE were performed before starting treatment and 6, 12, 18 and 24 months. RESULTS: Of the 60 patients included, only 45 completed the study (26 in the active group and 19 in the placebo group, P < 0.05). Two out of 30 (6.6%) patients dropped out because of insufficient efficacy in the active group compared to eight out of 30 (26.6%) in the placebo group (P < 0.05). There was a significant increase in the antigen threshold required to obtain a positive CPT from 8.2 IR [95% confidence interval (CI) 5.9-11.4] at baseline to 21.7 IR (95% CI 15.4-30.4) at 2 years (M24) in the active group, compared to 8.1 IR (95% CI 5.4-12.1) at baseline to 8.1 IR (95% CI 5.1-12.4) at M24 in the placebo group (P < 0.04 for overall treatment difference, P < 10-7 for the time-treatment interaction; repeated measures ANOVA). Differences between groups at individual time points were significant from 18 months on. Despite increased antigen concentrations, CPT scores were lower overall in the active than in the placebo group (P < 0.001). No serious adverse effects were reported. CONCLUSION: SLIT effectively increased the antigenic threshold required to obtain a positive CPT to house-dust mite antigen. Tolerance to and innocuity of SLIT were comparable to previous studies. This could justify recommending SLIT for the preventive treatment of perennial conjunctivitis caused by house dust mites.

Comparison of lodoxamide 0.1% ophthalmic solution and levocabastine 0.05% ophthalmic suspension in vernal keratoconjunctivitis.

PURPOSE: To compare the clinical efficacy and safety of lodoxamide 0.1% ophthalmic solution with levocabastine 0.05% ophthalmic suspension, each given four times daily (QID) for three months to patients with vernal keratoconjunctivitis (VKC). METHODS: The study was conducted multinationally according to a triple-masked parallel design in 95 VKC patients, with assessments at baseline then monthly during the three months of treatment. The primary efficacy variables were a Physician's Clinical Judgement Scale and a Patient's Overall Judgement Scale of improvements from baseline. Signs and symptoms of VKC were also assessed. RESULTS: Both primary efficacy variables showed significantly greater overall improvement of VKC from baseline with lodoxamide than levocabastine. The superiority of lodoxamide was demonstrated by the Physician's Clinical Judgement Scale at months 2 and 3, with a trend, at month 1, and by the Patient's Overall Judgement Scale at months 1, 2 and 3. All signs and symptoms of VKC improved significantly from baseline at all time points, regardless of treatment (p<0.001). However, relative to levocabastine, conjunctival discharge, photophobia and lacrimation were significantly reduced by lodoxamide at months 1, 2 and 3, itching at months 2 and 3, and bulbar conjunctiva at month 3. The temporal improvement of superior tarsal papillae did not differ significantly between treatments. Both were well tolerated. CONCLUSIONS: Lodoxamide 0.1% and levocabastine 0.05% eye drops, instilled four times daily for three months, were effective, safe and well tolerated by patients with VKC, but lodoxamide was significantly superior to levocabastine.

Clinical evaluation of twice-daily emedastine 0.05% eye drops (Emadine eye drops) versus levocabastine 0.05% eye drops in patients with allergic conjunctivitis.

PURPOSE: The efficacy and safety of emedastine 0.05% eye drops (Emadine; Alcon Laboratories, Inc, Fort Worth, Texas), a new H(1) antagonist, were studied in comparison to levocabastine 0.05% eye drops (Livostin; Janssen-Cilag N V, Berchem, Belgium) during a twice-daily treatment schedule for 6 weeks in adult and pediatric patients with seasonal allergic conjunctivitis. METHODS: In a prospective, multicenter, randomized, double-masked, parallel group study, 222 patients with allergic conjunctivitis were randomized (221 received treatment) to either emedastine or levocabastine, instilled twice daily for 6 weeks. Patient diaries were completed four times daily (before the morning and evening instillations, at noon, and in the afternoon), and clinical examinations were conducted at regular intervals. Primary efficacy variables of ocular redness and itching and secondary efficacy variables of chemosis, eyelid swelling, patient diary data, and physician's global assessment were analyzed. RESULTS: Both emedastine and levocabastine produced a statistically significant (P =.0001) reduction in itching and redness within 5 minutes of the first instillation. All signs and symptoms improved progressively over the 6-week treatment period. After 7 days of use, and throughout the remainder of the study, emedastine was statistically superior to levocabastine (P <.006) in preventing and alleviating the signs and symptoms (itching, redness, chemosis, and eyelid swelling) of allergic conjunctivitis. CONCLUSIONS: Emedastine 0.05% eye drops administered twice daily are more efficacious than levocabastine 0.05% eye drops in the prevention and treatment of the signs and symptoms of allergic conjunctivitis in adults and children of 4 years and above. Both emedastine 0.05% eye drops and levocabastine 0.05% eye drops were well tolerated.

Two chromene derivatives from Calyptranthes tricona.

Two alpha-monomethyl chromene derivatives were isolated from the leaf essential oil of Calyptranthes tricona from Brazil which were characterized by 1H- and 13C-NMR. Besides these components, which represent about half of the oil, classical terpenoid structures could be identified, among which cis-beta-farnesene is the most abundant (26.6%). A biosynthetic pathway could be proposed to explain the formation of the chromene derivatives in the plant.

[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.

[Fluctuations in uncorrected visual acuity after refractive surgery using intra-stromal corneal rings]. / Fluctuations de l'acuité visuelle sans correction après chirurgie réfractive par segments intra-cornéens.

PURPOSE: Refractive surgery is meant to provide early stable and good uncorrected visual acuity. Our main concern in this study was to take special interest in fluctuation in uncorrected acuity within the first three months after implantation of Schanzlin intracorneal ring segments (ICRS) produced by Keravision. PATIENTS AND METHODS: Ten eyes in 6 patients underwent implantation of 2 intrastromal corneal segments for myopias ranging from -1.00 to -3.50 Dipoters. Visual acuity was measured with cytoplegy on day one, on day 8, two weeks, 1 month, and 2 months after surgery. The fluctuations of visual acuity were noted between observations. RESULTS: Uncorrected visual acuity varied up to 4 lines without an obvious pattern of progression over time. Fifty percent of the eyes had a variation of 2 lines. The best spectacle corrected visual acuity was preserved in all patients. DISCUSSION: Corneal topography with measurement of keratometry, intraocular pressure, and examination of the anterior chamber must be studied to identify the parameter that could condition these fluctuations of visual acuity. No parameter was found to predict these variations that may result from individual corneal healing factors peculiar to each patient. The fluctuations of uncorrected visual acuity were relatively important during the 3 first postoperative months. In all patients, final uncorrected visual acuity was always at least 10/10.

Nedocromil sodium eye drops are more effective than sodium cromoglycate eye drops for the long-term management of vernal keratoconjunctivitis.

BACKGROUND: Vernal keratoconjunctivitis (VKC) is a severe though transient form of ocular allergy, predominant in young males, which requires careful management. Corticosteroids are effective but also cause serious topical side-effects in the eye, such as glaucoma and cataracts. The safer, mast cell stabilizing anti-inflammatories (commonly sodium cromoglycate) therefore have an important role. This parallel group study compared efficacy, tolerability and safety of sodium cromoglycate 2% with nedocromil sodium 2%, administered as one drop per eye four times daily for a period of 5 months. METHODS: Children aged 4-17 years, with a diagnosis of mostly limbal VKC in the last 12 months, entered a 2-week baseline during which they used only artificial tears, and were then randomized to treatment, in groups of 18, on an investigator single-masked basis. Daily symptom diary cards were kept by patients/guardians, and VKC was assessed by the clinician at approximately monthly intervals. Dexamethasone was provided for rescue control of severe symptoms, if needed. RESULTS: A total of 34 patients completed the study. Both trial treatments produced rapid improvements and many ocular signs and symptoms, including Trantas' dots, chemosis, itching, soreness and sticky discharge, were fully controlled by the end of the study. However, nedocromil sodium took effect more quickly, with a significant reduction compared to sodium cromoglycate for itching, grittiness, hyperaemia and keratitis within 6 weeks. In addition, nedocromil sodium was the more efficacious overall (significant vs sodium cromoglycate for hyperaemia, keratitis, papillae and pannus at 22 weeks). Both treatments were well tolerated and without serious adverse effects. Final opinions favoured nedocromil sodium, with full control of VKC recorded for 94% (patient opinion) and 100% (clinician opinion) of this treatment group, compared with 29% and 0%, respectively, in the sodium cromoglycate group. CONCLUSIONS: Nedocromil sodium 2% eye drops is significantly more effective than sodium cromoglycate for treatment of VKC.

[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.

[A new photocoagulation technic for severe non-proliferative diabetic retinopathy. A prospective study apropos of 54 cases]. / Nouvelle technique de photocoagulation des rétinopathies diabétiques non prolifératives sévères. Etude prospective à propos de 54 cas.

PURPOSE: This work deals with the photocoagulation treatment of severe NPDR, suggesting a new therapeutic practice. It is proposed to adopt treatment intensity to each clinical form, to preserve healthy territories through biomicroscopy and to evaluate the risk of complications inherent in this technique, and to be at least as efficient as comparative studies. MATERIAL AND METHOD: We treated 52 eyes and kept under observation 2 eyes which revealed severe NPDR. The patients were followed between 1991 and 1996. The approach was essentially biomicroscopic. Photocoagulation treatment utilized green, yellow or orange wavelengths through panoramic contact lenses. RESULTS: After an average follow-up of 30 months, there was a decrease of visual acuity of 0.72 to 0.64 (Monoyer scale); a severe visual loss in 1.8% of the cases; and an early decrease in visual acuity at 6 weeks in 7.4% of the cases. A "High Risk" PDR occurred in 3.7% of the cases and we had to perform a vitrectomy (1.85% of the cases). We treated with less than 1600 I in 68.5% of the cases and with more than 1600 I in 31.5% of the cases. Patients had 5.5 photocoagulation sessions and were examined every 3.5 months on average. CONCLUSION: We believe our therapeutic approach is interesting, by comparison with other studies, but that it can be improved. All patients show a primary condition in the nasal field which, if treated too massively, becomes unable to see and disturbs daily life. We also note the severe potential for progression in insulin-dependent patients.

[Actinic keratosis of the conjunctiva. Apropos of a clinical case]. / Kératose actinique de la conjonctive. A propos d'un cas anatomo-clinique.

We report a slowly progressive and whitish limbal conjunctival tumor that occurred in a 73-year-old man. An excisional biopsy specimen of this conjunctival tumor was submitted for histopathologic evaluation. The diagnosis of conjunctival actinic keratosis was based on following cellular abnormalities: epithelial hyperplasia acanthosis, keratosis or parakeratosis with discrete papillomatosis and some atypia. The basement membrane was intact. An area of elastotic degeneration in the subtantia propria, was considered as one of the characteristic features of this conjunctival precancerous condition related to excessive sun exposure. By hybridization in situ, the detection of human papilloma virus (HPV) was negative. Keratosis actinic needs to be distinguished from other precancerous conditions showing similar clinical features such as dysplasia and carcinoma in situ appearing to affect the prognosis.

Treating severe eye allergy.

Allergic eye conditions, particularly seasonal allergic conjunctivitis (SAC), are common. Itching, oedema and hyperaemia are relieved with topical H1-antagonists or sodium cromoglycate. The newer mast-cell stabilizing agent nedocromil sodium has a similar safety profile to sodium cromoglycate, but is more potent and has a more convenient twice-daily dosing regimen. When several placebo-controlled studies of its use in the treatment of SAC were analysed, it was found that 80% of patients reported symptom relief. In a further study, nedocromil sodium eyedrops (twice-daily dosing) had similar overall efficacy to sodium cromoglycate eyedrops (four-times-daily dosing) in subjects with SAC during the birch season, but during the period of highest pollen challenge, only the former agent was significantly more effective than placebo. Another study found that nedocromil sodium had efficacy equivalent to levocabastine over 7 days, but tended to have a more rapid onset of action. In patients with perennial allergic conjunctivitis (PAC) unresponsive to sodium cromoglycate, both clinicians and patients reported significantly better control of symptoms with nedocromil sodium eyedrops than with placebo. Recently, in a long-term study of treatment for vernal keratoconjunctivitis (VKC), it was found that nedocromil sodium 2% eyedrops produced a more rapid and marked improvement in symptoms than sodium cromoglycate 2% eyedrops and enabled lower use of steroid rescue medication. Both drugs were well tolerated and without serious side-effects.

Treatment of common ocular allergic disorders; a comparison of lodoxamide and NAAGA.

BACKGROUND/AIMS: Lodoxamide tromethamine and N-acetyl-aspartyl glutamic acid (NAAGA) are mast cell stabilisers, both of which have been shown to be effective in the treatment of allergic conjunctivitis. The aim of this study was to compare the two compounds in patients with common ocular allergic disorders. METHODS: 73 patients participated in a double masked, randomised multicentre study. Diagnoses were chronic allergic conjunctivitis, vernal conjunctivitis, seasonal and atopic conjunctivitis. 36 patients were treated with lodoxamide 0.1% and 37 with NAAGA 4.9%, the drops being instilled four times daily for up to 56 days. RESULTS: The overall opinion of the physicians and the patients was in favour of lodoxamide at day 10 of the study. At this time, 86% of lodoxamide treated and 49% of NAAGA treated patients considered they had improved. The patients' opinion favoured lodoxamide at day 28 and both physicians' and patients' evaluations were in favour of lodoxamide at day 42. Evaluation of signs and symptoms indicated superiority of lodoxamide at days 42 and 56. Both treatments were well tolerated. CONCLUSION: While both lodoxamide and NAAGA treatments are associated with clinical improvements in patients with allergic conjunctivitis, lodoxamide may have an earlier onset of action.

[Information and education interventions on hygiene levels of a population in which trachoma exists in a hyperendemic and serious form]. / Interventions informatives et éducatives sur les mesures d'hygiène au sein d'une population dans laquelle sévit le trachome sous forme hyperendémique et grave.

The aim of this work is to develop information and education methods in order to obtain better hygienic conditions in Tissint Zaouia (Moroccan province of Ouarzazate). 41% of the population is affected by trachoma with a rate of 18% of active trachoma, 1.6% of the population has a blindness of corneal origin. Topical treatment and surgery of trichiasis must be associated to a better hygiene of the community. Until now mothers and families have not fully perceived the connection between flies and insufficiency of narsing and trachoma transmission. Our specific goals are the following: A--information of target population, B--better understanding of hygiene by mothers and families, C--incitation to face-washing of children, D--perfect identification of trachoma signs by health workers, E--official integration of this program by local authority, F--evaluation of trachoma incidence.

[Cause of blindness in the province of Giang-Vietnam]. / Causes de cécité dans la province d'An Giang-Vietnam.

An Giang province is one of many provinces of Mekong Delta, South of Vietnam, with 2 million people and 85% population living in the countryside for agriculture. Main causes of blindness are leucoma secondary to trachoma and mycoses (16%) closed angle glaucoma (5%) and cataract (50%). Percentage of eyes requiring ocular surgery is 0.88% of total population. 1200 patients had surgery during year 1995; as 16,000 patients are waiting for surgery, we stress that this backlog must be reduced as soon as possible. On an other hand, we intend to develop corneal transplantation.

[Identification of latent forms of Chlamydia trachomatis in the conjunctiva signifying "new interpretation of ocular chlamydia infections"]. / L'identification des formes latentes de chlamydia trachomatis au niveau de la conjonctive signifie "interprétation nouvelle des chlamydioses oculaires".

Chlamydia trachomatis (CT) sérovar D through K was demonstrated with electron microscopy and biology in 114 patients with bilateral dry eyes. Long time ago latent CT was recognised in conjunctival epithelium of vernal kerato conjunctivitis patients. CT was found in conjunctival section of patients with an extinct trachoma. Aberrants forms of chlamydia bear the responsibility of this long lasting infection. Reticuled body does not product elementary bodies. It becomes an aberrant body which could remain latent during years. DIF and others classical investigations are negatives because abberrant chlamydiae have lost most part of their MOMP albeit keeping immunopathogenicity.

Ciprofloxacin ophthalmic solution in the treatment of conjunctivitis and blepharitis: a comparison with fusidic acid.

The efficacy and safety of ciprofloxacin ophthalmic solution (0.3%) and fusidic acid gel (1%) were compared in the treatment of bacterial conjunctivitis and blepharitis in a randomized, open, parallel group study. Thirty-nine patients, 21 treated with ciprofloxacin solution and 18 treated with fusidic acid gel, were culture-positive on admission and were evaluable for efficacy. At the end of a 7-day treatment, the infecting organism was eradicated in 81% of those treated with ciprofloxacin and 72% of those treated with fusidic acid gel. There was clinical cure or improvement in 95% and 89% respectively. The clinical cure rate appeared to be higher with ciprofloxacin than fusidic acid (62% compared with 28%) but this was related to the higher proportion of patients with acute conjunctivitis in the ciprofloxacin group. Two patients using ciprofloxacin had mild discomfort and stinging on instillation and one given fusidic acid had moderate edema and discomfort; the latter patient stopped treatment. Topical ciprofloxacin is effective and well tolerated and is a useful treatment of bacterial conjunctivitis and blepharitis.

[Observatoire des Allergies Oculaires. National epidemiological survey of chronic (perennial) allergic conjunctivitis and/or keratoconjunctivitis seen in ophthalmology]. / Observatoire des Allergies Oculaires. Enquête épidémiologique nationale sur les conjonctivites et/ou kérato-conjonctivities allergiques chroniques (per-annuelles) suivies en ophtalmologie.

A second epidemiological ocular allergy survey was carried out by ophthalmologists during the winter of 94/95 in order to define the main characteristics of patients suffering from chronic, perennial allergic conjunctivitis or keratoconjunctivitis. From the data collected from a wide sample of 791 patients, we were able to describe the main symptoms and lesions related to chronic ocular allergy, its evolution and the allergens involved. Allergic symptoms (conjunctival redness, foreign body sensation, itching) are reported in 98.5% of patients. Non specific symptoms (burning, photophobia, blurred vision, ocular dryness) are reported in 3 patients out of 4. 40% of patients have perennial manifestations without any seasonal exacerbation while 1 patient in 2 suffers from a seasonal worsening. In 80% of the cases, the responsible allergens are domestic (house dust, miles), 60% of patients are affected by at least 2 allergens. Ophthalmic examination shows lesions of the tarsal conjunctiva (papillas, follicles) in 94% of the cases and corneal lesions in practically 50% of the patients. This epidemiological survey shows the necessity of having a rigourous clinical approach which includes a complete ophthalmological examination which is the only thorough means of assessing the allergic lesions and proposing the most suitable treatment for day to day ophthalmic practice.

Comparative evaluation of efficacy and safety of ciprofloxacin and norfloxacin ophthalmic solutions.

The efficacy and safety of ciprofloxacin ophthalmic solution 0.3% and norfloxacin ophthalmic solution 0.3% in the treatment of bacterial conjunctivitis and blepharitis were compared in a double masked randomised study. A total of 131 patients, 65 treated with ciprofloxacin (42 with conjunctivitis and 23 with blepharitis) and 66 treated with norfloxacin (39 with conjunctivitis and 27 with blepharitis) were enrolled in the study at five centres in France. In the efficacy population, pathogens were eradicated or reduced in 96% (24/25) of patients in the ciprofloxacin group and 89% (24/27) in the norfloxacin group. There was no difference between treatments with regard to eradication of particular pathogens. In the efficacy population, clinical cure or improvement was seen in 96% of the patients (24/25 in the ciprofloxacin group and 26/27 in the norfloxacin group). There were no significant differences between ciprofloxacin and norfloxacin with respect to improvements in four symptoms or ten clinical signs. No serious treatment-related adverse events were reported and both ciprofloxacin and norfloxacin were well tolerated.

[New vaccine against trachoma]. / Nouveau vaccin contre le trachome.

The new vaccine against trachoma is established upon a stimulation of MALT system by oral route. The amount of IgA produced using chlamydia trachomatis serovar C is sufficient to allow a protection against infections of the same species of chlamydiae and/or of others varieties. There is a cross immunity between different serovars and different species. The vaccine could bring a protection against trachoma, chlamydial infection of human and animals.

[Ocular Allergy Observatory. National epidemiological survey of seasonal allergic keratoconjunctivitis seen in ophthalmology]. / Observatoire des Allergies Oculaires. Enquête épidémiologique nationale sur les kératoconjonctivites allergiques saisonnières vues en ophtalmologie.

The main objective of this first epidemiological ocular allergy survey was to precise the profile of patients with an ocular allergy, especially in terms of antecedents, clinical type and trigger or favourising factors, in order to better determine the evolution of the type of diagnosed allergy. This survey covered 399 sufferers drown from amongst general ophthalmologists patients consulting for ocular allergy. Three main points which came out of the survey were: - the chronic aspect of this pathology and the multiplicity of responsible allergens; - the almost permanent existence of conjunctival lesions (9 patients out of 10) and corneal epithelial disease (1 patient out of 3); - the need for an extremely rigourous and thorough questioning of the patient and a complete ophthalmologic examination covering not only the symptoms but equally the lesions of ocular allergy.