[Review by the French Glaucoma Society on the roles of new surgical techniques in glaucoma]. / Mise au point de la Société française du glaucome sur la place des nouvelles techniques chirurgicales dans le glaucome.

The surgical management of glaucoma has been enriched in recent years by the arrival of new surgical techniques as a group known as MIGS (minimally invasive glaucoma surgery). The objective of these new techniques is to reduce intraocular pressure (IOP) while limiting the risk of complications of conventional filtering surgery and allowing faster visual recovery. MIGS can be classified into three main categories depending on the route used to promote the outflow of aqueous humor: the trabecular route, the suprachoroidal route and the subconjunctival route. MIGS using the subconjunctival route are also called minimally invasive bleb surgery (MIBS). These new techniques do not replace conventional filtering surgery, which remains the gold standard technique, but now offer new alternatives for the surgical management of glaucoma patients in combination with cataract surgery or as stand-alone procedures.

A fast technique to measure the dewpoint pressure of a retrograde condensate gas using a microfluidic volume.

A new method to determine the dewpoint pressure of a retrograde condensate from a fast, non-equilibrium measurement performed in a microfluidic optical cell is presented. The inflection point of the optical transmission recorded during depressurization agrees well with the dewpoint pressure of the sample, determined by conventional laboratory techniques. With this new technique, a measurement can be performed in less than 5 min and requires far less than a milliliter of the sample. Benchmarking of this technique is presented using four retrograde condensate samples, which were created in the laboratory using multi-component compositions that are based on oilfield samples. Each sample was characterized at three different temperatures, and their maximum relative liquid volumes (maximum liquid volume/total system volume at the dewpoint pressure) ranged from 1.3% to 13.5% for these temperatures. The dewpoint pressure measured by this technique differs by no more than 100 psi from that measured in a conventional laboratory for samples of a richness of 4% or higher, while leaner samples display a difference of ∼200 psi.

Use of auditory steady-state responses in children and comparison with other electrophysiological and behavioral tests.

OBJECTIVE: In patients who cannot or will not cooperate in behavioral hearing assessment, electrophysiological examinations are used, but are time-consuming because the subject has to remain immobile. The aim of this study was to assess whether auditory steady-state responses (ASSR) are sufficiently reliable, compared to auditory brainstem responses (ABR) and free-field audiometry, for assessment to begin with ASSR instead of ABR. MATERIAL AND METHODS: A retrospective study was performed between January 2012 and April 2013, including children less than 6 years of age who could not be tested via headphones. ASSR and ABR were measured during natural sleep or under phenobarbital-alimemazine sedation. Subjective pure-tone audiometry was performed, using the visual reinforcement audiometry method, in 69 children who were able and willing to cooperate. RESULTS: A total of 175 children were included. ASSR and ABR thresholds showed good positive correlation (338 ears; Pearson's correlation coefficient, 0.87). Behavioral thresholds correlated significantly with ASSR thresholds (Student t-test for matched series; P<0.05). ASSR thresholds were usually better than behavioral thresholds, with a difference of 8-15dB HL. CONCLUSION: ASSR is reliable in children under 6 years of age, and should be performed before ABR when hearing threshold rather than latency is to be determined.

[Visual field progression in glaucoma: cluster analysis]. / Progression du champ visuel dans le glaucome: intérêt de l'analyse de l'évolution des clusters.

BACKGROUND: Visual field progression analysis is one of the key points in glaucoma monitoring, but distinction between true progression and random fluctuation is sometimes difficult. There are several different algorithms but no real consensus for detecting visual field progression. The trend analysis of global indices (MD, sLV) may miss localized deficits or be affected by media opacities. Conversely, point-by-point analysis makes progression difficult to differentiate from physiological variability, particularly when the sensitivity of a point is already low. The goal of our study was to analyse visual field progression with the EyeSuite™ Octopus Perimetry Clusters algorithm in patients with no significant changes in global indices or worsening of the analysis of pointwise linear regression. PATIENT AND METHOD: We analyzed the visual fields of 162 eyes (100 patients - 58 women, 42 men, average age 66.8 ± 10.91) with ocular hypertension or glaucoma. For inclusion, at least six reliable visual fields per eye were required, and the trend analysis (EyeSuite™ Perimetry) of visual field global indices (MD and SLV), could show no significant progression. The analysis of changes in cluster mode was then performed. In a second step, eyes with statistically significant worsening of at least one of their clusters were analyzed point-by-point with the Octopus Field Analysis (OFA). RESULTS: Fifty four eyes (33.33%) had a significant worsening in some clusters, while their global indices remained stable over time. In this group of patients, more advanced glaucoma was present than in stable group (MD 6.41 dB vs. 2.87); 64.82% (35/54) of those eyes in which the clusters progressed, however, had no statistically significant change in the trend analysis by pointwise linear regression. CONCLUSION: Most software algorithms for analyzing visual field progression are essentially trend analyses of global indices, or point-by-point linear regression. This study shows the potential role of analysis by clusters trend. However, for best results, it is preferable to compare the analyses of several tests in combination with morphologic exam.

[Ocular blood flow in glaucoma]. / Le flux sanguin oculaire dans le glaucome.

In clinical practice, the vascular factor seems to be essential in glaucoma. Nevertheless, the various studies investigating the relations between the changes in ocular blood flow and risk of glaucoma often have diverse and contradictory conclusions. The variety of the methods in studies on ocular blood flow, the absence of a reference examination, and the absence of large clinical studies probably explain the problems bringing to light an indisputable relation. However, it remains essential, in any glaucoma, to look for and treat the vascular risk factor and most particularly to decrease intraocular pressure, the treatment that currently remains the most reliable to improve ocular blood flow.

InGaAs quantum dots grown by molecular beam epitaxy for light emission on Si substrates.

The aim of this study is to achieve homogeneous, high density and dislocation free InGaAs quantum dots grown by molecular beam epitaxy for light emission on silicon substrates. This work is part of a project which aims at overcoming the severe limitation suffered by silicon regarding its optoelectronic applications, especially efficient light emission device. For this study, one of the key points is to overcome the expected type II InGaAs/Si interface by inserting the InGaAs quantum dots inside a thin silicon quantum well in SiO2 fabricated on a SOI substrate. Confinement effects of the Si/SiO2 quantum well are expected to heighten the indirect silicon bandgap and then give rise to a type I interface with the InGaAs quantum dots. Band structure and optical properties are modeled within the tight binding approximation: direct energy bandgap is demonstrated in SiO2/Si/InAs/Si/SiO2 heterostructures for very thin Si layers and absorption coefficient is calculated. Thinned SOI substrates are successfully prepared using successive etching process resulting in a 2 nm-thick Si layer on top of silica. Another key point to get light emission from InGaAs quantum dots is to avoid any dislocations or defects in the quantum dots. We investigate the quantum dot size distribution, density and structural quality at different V/III beam equivalent pressure ratios, different growth temperatures and as a function of the amount of deposited material. This study was performed for InGaAs quantum dots grown on Si(001) substrates. The capping of InGaAs quantum dots by a silicon epilayer is performed in order to get efficient photoluminescence emission from quantum dots. Scanning transmission electronic microscopy images are used to study the structural quality of the quantum dots. Dislocation free In50Ga50As QDs are successfully obtained on a (001) silicon substrate. The analysis of QDs capped with silicon by Rutherford Backscattering Spectrometry in a channeling geometry is also presented.

[Ocular intolerance to antiglaucoma medications is underestimated]. / Tolerance locale des medications antiglaucomateuses un probleme sous-estime.

Since about 20 years, the large panel of the antiglaucoma eyedrops has drastically changed the management of glaucoma. Indications for filtering surgery had decreased in frequency. A great number of patients are controlled only by medications. However ocular intolerance and side effects have been reported until in 50% of the cases with 10% of severe manifestations of intolerance. Ocular side effects to topical medications may very often alter compliance. Ocular intolerance had been shown to be secondary to immunological mechanisms and direct or indirect toxicity. The immunological or allergic mechanisms are induced by a type I or IV hypersensibility and only represent 3% to 10% of all the side effects induced by topical medications. Toxic effect can be a direct through different mechanisms: pure toxic effect, acid pH, osmolarity of the solution, photosensibilisation. This will induce inflammatory reaction that will produce fibrosis in the long term. This toxic effect can be worsened by eye dryness or rosacea. Toxicity can also be indirect through an alteration of the conjunctival microbial flora and/or the lacrymal secretion. Concomitant obstruction of the lacrymal ducts may also contribute to this effect. These mechanisms could have been elucidated thank to histological studies from conjunctival mark, and more recently with confocal HRT, which gives an analysis of the ocular surface in vivo. Appropriate and early detection of intolerance to antiglaucoma medications is mandatory to adjust management strategies accordingly. These are based on the suppression or the reduction of conservative agents whenever possible, the use of fixed combinations, the reduction of the number of the instillations and the associated treatment of the ocular surface.

Cladocera of the Lençóis Maranhenses (NE - Brazil): faunal composition and a reappraisal of Sars' Method.

We studied the Cladocera of a group of ephemeral interdunal pools in the Lençóis Maranhenses, Maranhão State (NE - Brazil) and recorded 34 species. The fauna was overwhelmingly neotropical, with no evidence of invasive species. Species composition differed in Lagoa da Colher, an acid system. We provide notes on behaviour, morphology and taxonomy of some lesser-known anomopods, with emphasis on the Chydoridae. We figure male Oxyurella longicaudis, Chydorus eurynotus, Disparalona leptorhyncha, Alonella dadayi and A. clathratula. We provide notes on the "Sars' Method", hatching of freshwater crustaceans from dry mud, a simple technique that complements the information of hit-and-run surveys. About half of the total species number (44%) was revived through this method; 18% of species were additional to field-collected samples. The Sars' method also yielded abundant specimens of rare species, useful for identification and studies on behaviour.

[Intraocular pressure measurement in children]. / La mesure de la pression intra-oculaire chez l'enfant.

Intraocular pressure (IOP) measurement in children is often difficult to perform because younger children are non-compliant and resisting the examination. Normal IOP in children is not well established yet because in the studies reporting about IOP, the instruments used and clinical conditions have varied. Non contact tonometer often overestimates IOP in blinking children and is not always reliable. But all the others measurement techniques use contact (GAT, Perkins, Tono-Pen, ORA, RBT), and are not always suitable and easy-touse. Under general anaesthesia, mean IOP measured with Perkins applanation tonometer is under 8 mmHg before age of 3 months and under 12 mmHg between ages of 6 and 9 months. After, IOP shows an increasing trend with age of 1 mmHg per year up to 12 years. Some studies have proposed as normal pediatric IOP: To=0.71 x age (years) +10, up to age 10. Then, IOP tends to approach adult levels by 12 years of age. However pediatric glaucoma is rare: congenital glaucoma, before age of 3 years, autosomal dominant juvenile glaucoma, with family history of glaucoma and elevated IOP, or secondary glaucoma with special context. Thus, hypertony has to be confirmed by another measurement technique, correlated to central corneal thickness, and clinical examination (optic nerve head and visual field).

[Long term follow-up of bleb reconstruction after glaucoma filtering surgery]. / Réfection de bulle de filtration après chirurgie du glaucome. Résultats tonométriques à moyen terme.

PURPOSE: To study the long term outcomes of surgical bleb reconstruction after glaucoma filtering surgery. METHOD: A retrospective study of 46 eyes (43 patients, mean age 67.9 years +/-12.2, 30 women, 13 men) that underwent surgical bleb reconstruction for leaking bleb (56.53%), major bleb dysesthesia (17.39%), or extend bleb over cornea (26.08%). Bleb resection associated with the covering of filtering surgery site with conjunctival flap was performed 38.5 months (+/- 45.2) after initial filtering surgery. RESULTS: After a follow up of 24.3 months (+/- 17.9), intra ocular pressure was increased in 85.2% eyes: +3.56 mmHg (+/- 4.3, p<0,001), and a new hypotonic medication was needed in 26 %. Bleb dysesthesia was reduced in any case and none of the bleb was leaking any more. CONCLUSION: Bleb excision with conjunctival advancement is a safe and effective procedure for the treatment of late bleb leak or major bleb dysesthesia. However in most cases, intra ocular pressure increase after reconstruction and new hypotensive medication may be required.

[Clinical factors favoring excessive subconjunctival fibroblastic proliferation after glaucoma surgery]. / Facteurs cliniques favorisant la cicatrisation conjonctivale excessive après chirurgie du glaucome.

PURPOSE: To understand risk factors for failure of glaucoma filtering surgery. PATIENTS: A retrospective study of 67 eyes (16 nonpenetrating trabeculectomies, 51 trabeculectomies [31 with 5FU and 20 with mitomycin]) of 61 patients in whom 5FU bleb revision was needed because of increasing intraocular pressure. Postoperative incidents were analyzed to explain excessive subconjunctival fibroblastic proliferation. RESULTS: In eight cases, IOP increased after 6.16 months (+/-2) and for 59 eyes, after 33.5 days after surgery (+/-11.4). Postoperative incidents were 24 (35.9%) bleb leaks, nine cases (13.4%) of hypotony with choroidal detachment, six (9.0%) iris incarcerations, seven (10.4%) cystic blebs, and 21 (31.3%) inflammatory flat blebs. After a mean follow-up of 27 months +/- 18, the success of bleb 5FU revision was 84.6% for nonpenetrating trabeculectomy (without glaucoma treatment, 69.2%; with medical treatment, 15.4%) and 73.9% for trabeculectomy (47.8% and 32.6%). CONCLUSION: Postoperative outcomes favor an inner or outer obstacle to conjunctival filtration. Aqueous humor can no longer remain in the subconjunctival spaces, increasing the risk of glaucoma surgery failure. Early follow-up of glaucoma surgery is crucial to obtaining long-lasting filtration.

A delayed Boerhaave's syndrome diagnosis treated by thoracoscopy in prone position.

Boerhaave's syndrome or postemetic rupture of the esophagus, carries a high morbidity and mortality. The authors report a delayed Boerhaave's syndrome diagnosis (3 days), successfully treated by right thoracoscopic debridement in prone position. Thanks to gravity the cardiopulmonary bloc drops back and the access to the esophagus is direct allowing for accurate placement of the chest tubes near the perforation. The procedure is completed by laparoscopic placement of a feeding jejunostomy with the patient supine.

[What should we think? Is pneumotonometry still reliable?]. / Que faut-il en penser? La tonométrie à air est-elle encore fiable?

UNLABELLED: Noncontact tonometer (NCT) is an applanation tonometry, as is Goldmann tonometry. Numerous studies have shown the reliability of this technique but problems still exist. METHOD: We measured intraocular pressure (IOP) in 340 patients (668 eyes) with NCT and Goldmann tonometer (GAT). To evaluate the influence of central corneal thickness (CCT), we classified the patients according to their CCT (<500 microm; between 520 and 580 microm, and>600 microm). RESULTS: The mean difference between the two IOP measurements was -1.4 mmHg +/- 2.67 (-12 to +7), p<0,0001 for the thinner corneas, +0.13 mmHg +/- 2.67 (-8 to +8), p=0.445 for the regular corneas, and + 3.04 mmHg +/- 3.2 (-7 to +13) p<0.0001 for the thicker corneas. CCT influences NCT and GAT, but the difference between the two techniques is higher for thicker CCTs, higher IOPs, and in younger patients. CONCLUSION: NCT is good for glaucoma screening but is less reliable than GAT for glaucoma follow-up if CCT and IOP are far from regular values.

Optimization and scale-up of a fluid bed tangential spray rotogranulation process.

The production of pellets in the pharmaceutical industry generally involves multi-step processing: (1) mixing, (2) wet granulation, (3) spheronization and (4) drying. While extrusion-spheronization processes have been popular because of their simplicity, fluid-bed rotogranulation (FBRG) is now being considered as an alternative, since it offers the advantages of combining the different steps into one processing unit, thus reducing processing time and material handling. This work aimed at the development of a FBRG process for the production of pellets in a 4.5-l Glatt GCPG1 tangential spray rotoprocessor and its optimization using factorial design. The factors considered were: (1) rotor disc velocity, (2) gap air pressure, (3) air flow rate, (4) binder spray rate and (5) atomization pressure. The pellets were characterized for their physical properties by measuring size distribution, roundness and flow properties. The results indicated that: pellet mean particle size is negatively affected by air flow rate and rotor plate speed, while binder spray rate has a positive effect on size; pellet flow properties are enhanced by operating with increased air flow rate and worsened with increased binder spray rate. Multiple regression analysis enabled the identification of an optimal operating window for production of acceptable pellets. Scale-up of these operating conditions was tested in a 30-l Glatt GPCG15 FBRG.

[Diode laser in "Malignant Glaucoma" treatment]. / Le laser Diode dans le traitement du "Glaucome Malin".

UNLABELLED: Malignant glaucoma remains one of the most dramatic complications of ocular surgery. It can occur after glaucoma surgery but also after iridotomy, capsulotomy, or cataract extraction. However, the mechanisms remain unclear. PURPOSE: to evaluate diode laser cyclodestruction as a complementary treatment in refractory malignant glaucoma. PATIENTS: Seven women with malignant glaucoma with onset several months before (mean, 43 months; range, 12-96 months), in whom shallow anterior chamber and high IOP (25 mmHg +/- 5.5 treated with 2.86 +/- 0.9 topical and systemic medications) persisted despite prior surgical treatment (mean, 2; range, 1-5). Controlateral eyes had hyperopia (mean, +3.7 D, range, +1 to +6), five had shallow anterior chamber and high IOP. UBM detected plateau iris in four women. METHODS: Seven eyes with malignant glaucoma and three controlateral eyes underwent cyclodestruction with diode laser (Viridis Twin Quantel Medical, laser, 810 nm), 22 burns around 270 degrees , 2 mm from the limbus for glaucomatous eyes and 15 inferior burns for controlateral eyes. RESULTS: Resolution of malignant glaucoma, with lower pressure (mean, 35%; range, 10%-70%), lower levels of medications (64%), final IOP at 13.2 mmHg (+/- 4.7), and deepening anterior chamber was achieved in all cases (mean follow-up, 18 months; range, 12-22). Cycloplegic topical treatment was stopped in 70% of cases. CONCLUSION: Diode laser cyclodestruction can help to resolve refractory malignant glaucoma. Larger UBM studies could help us to better understand the mechanisms of malignant glaucoma.

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.

[HRT and glaucoma surgery follow-up]. / HRT et suivi des glaucomateux opérés.

Heidelberg Retina Tomography (HRT) analysis of the optic nerve might be temporarily modified after glaucoma surgery. However, optimal follow-up of glaucoma patients requires comparing reliable optic nerve images. The aim of this study was to define the consequences of glaucoma surgery on HRT measurements. Results showed temporary modifications until at least the third month, suggesting that it is better to wait 6 months after surgery to obtain reliable measurements.

Phylogenetic relationships inferred from ribosomal its sequences and biogeographic patterns in representatives of the genus Calopteryx (Insecta: Odonata) of the West Mediterranean and adjacent West European zone.

Western Europe is a reinvasion zone for the riverine dragonfly genus Calopteryx (Insecta: Odonata). Reinvasion may have been from central West Asia or from the West Mediterranean refugium. Phylogenetic relationships of West Mediterranean and West European taxa of the genus Calopteryx from different localities were inferred from sequences of the internal transcribed spacers (ITS1 and ITS2) of the nuclear ribosomal RNA genes. Twenty-six taxa belonging to the species groups C. splendens, C. meridionalis, C. haemorrhoidalis, C. virgo, C. xanthostoma, and C. exul were analyzed, with two North American species, C. amata and C. aequabilis, as outgroup. Sequence data and phylogenetic analyses were used to infer biogeographical patterns. The ribosomal spacers (ITS1 and ITS2) and the intervening 5.8S rDNA gene were amplified by PCR and sequenced. The ITS2 sequences of the West Mediterranean and West European calopterygids show no length variation but the ITS1 region was slightly variable in length. The sequence variation for ITS1 and ITS2 regions between different West Mediterranean and West European calopterygids was 14.5 and 6.1%, respectively. Phylogenetic relationships inferred from ITS sequences only partly confirm morphological data. A monophyletic origin of all West Mediterranean and West European species emerged. They are separated into two main clades; the splendens-like forms and the virgo/meridionalis/haemorrhoidalis group. Intraspecific variability, indicating different stages of speciation, was detected only in West Mediterranean representatives (e.g., C. xanthostoma) but not in invasive representatives in West Europe. The North African endemic C. exul is more closely related to the Italian C. s. caprai than to C. splendens sensu strictu. Based on the present information, Cretan populations are the only splendens-like taxa in addition to C. s. caprai that deserve subspecies status.

[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.

[Contribution of individual characteristics to learning by children with first exposure to a prevention of abuse program]. / La contribution des caractéristiques individuelles aux apprentissages des enfants du primaire participant à un atelier de prévention des abus.

This study explores the contribution of personal characteristics in the knowledge and skills gains of children taking part in the child abuse prevention program ESPACE. The program is an adaptation of the widely implemented American Child Assault Prevention Program (CAP). A group of 107 fourth-grade children completed a knowledge questionnaire and a video vignette measure designed to evaluate preventive skills in abusive and potentially abusive situations. Children were also invited to complete questionnaires evaluating individual characteristics such as self-esteem, locus of control and self-efficacy. The results highlight the importance of certain individual variables such as the child's gender, self-efficacy and perception of athletic competence in the acquisition of sexual abuse preventive skills.