[Glaucoma and optic nerve drusen: Limitations of optic nerve head OCT]. / Glaucome et drusen du nerf optique : les limites de l'OCT papillaire.

INTRODUCTION: Optic nerve head drusen are congenital calcium deposits located in the prelaminar section of the optic nerve head. Their association with visual field defects has been classically described, but the diagnosis of glaucoma is not easy in these cases of altered optic nerve head anatomy. CASE STUDY: We describe the case of a 67-year-old man with optic nerve head drusen complicated by glaucoma, which was confirmed by visual field and OCT examination of the peripapillary retinal nerve fiber layer (RNFL), but the measurement of the minimum distance between the Bruch membrane opening and the internal limiting membrane (minimum rim width, BMO-MRW) by OCT was normal. DISCUSSION: OCT of the BMO-MRW is a new diagnostic tool for glaucoma. Superficial optic nerve head drusen, which are found between the internal limiting membrane and the Bruch's membrane opening, overestimate the value of this parameter. CONCLUSION: BMO-MRW measurement is not adapted to cases of optic nerve head drusen and can cause false-negative results for this parameter, and the diagnosis of glaucoma in this case should be based on other parameters such as the presence of a fascicular defect in the retinal nerve fibers, RNFL or macular ganglion cell complex thinning, as well as visual field data.

[Regression of myelinated retinal nerve fibers in a case of primary open-angle glaucoma]. / Régression des fibres nerveuses rétiniennes myélinisées dans un cas de glaucome primitif à angle ouvert.

Myelinated retinal nerve fibers observed rarely on ocular fundus examination, usually adjacent to the optic disc, are known to be stable throughout life. However, the possibility of rarefaction, and even disappearance, of these myelinated fibers has been pointed out in very rare cases of ocular or neuro-ophthalmological pathologies. We report such a regression, identified after a six-year period, in one case of primary open-angle glaucoma.

Use of combinations of in vitro quality assessments to predict fertility of bovine semen.

Predicting in vivo fertility of bull ejaculates using in vitro-assessed semen quality criteria remains challenging for the breeding industry. New technologies such as computer-assisted semen analysis (CASA) and flow cytometry may provide accurate and objective methods to improve semen quality control. The aim of this study was to evaluate the relationship between semen quality parameters and field fertility of bull ejaculates. A total of 153 ejaculates from 19 Holstein bulls have been analyzed using CASA (postthawing semen motility and morphology) and several flow cytometric tests, including sperm DNA integrity, viability (estimated by membrane integrity), acrosomal integrity, mitochondria aerobic functionality and oxidation. Samples were analyzed both immediately after thawing and after 4 hours at 37 °C. A fertility value (FV), based on nonreturn rate at 56 days after insemination and adjusted for environment factors, was calculated for each ejaculate. Simple and multiple regressions have been used to correlate FV with CASA and flow cytometric parameters. Significant simple correlations have been observed between some parameters and FV (e.g., straight line velocity [µm/s], r(2) = -0.12; polarized mitochondria sperm (%), r(2) = 0.07), but the relation between simple parameter and FV was too week to predict the fertility. Partial least square procedure identified several mathematical models combining flow cytometer and CASA variables and had better correlations with FV (adjusted r(2) ranging between 0.24 and 0.40 [P < 0.0001], depending on the number of included variables). In conclusion, this study suggests that quality assessment of thawed bull sperm using CASA and flow cytometry may provide a reasonable prediction of bovine semen fertility. Additional work will be required to increase the prediction reliability and promote this technology in routine artificial insemination laboratory practice.

[Glaucoma medications, preservatives and the ocular surface.] / Traitement du glaucome, conservateurs et surface oculaire.

Several clinical and experimental studies have demonstrated that ocular surface disease is common in glaucoma patients receiving chronic glaucoma drops, and that the preservatives in these drops play a major role in the occurrence of ocular surface disease. These ocular surface changes may induce both symptoms reported by the patients and anterior segment clinical signs, and should be systematically assessed by history and exam in all glaucoma patients. In these patients with ocular surface disease, reducing the amount of preservatives administered to the eye should be strived for, rather than adding additional eye drops to alleviate or mask the side effects of the glaucoma drops.

Effect of post-thaw dilution with caffeine, pentoxifylline, 2'-deoxyadenosine and prostatic fluid on motility of frozen-thawed dog semen.

The aim of the experiment was to evaluate the motility pattern of frozen-thawed canine semen to which pentoxifyilline (PTX), caffeine (CAF), 2'-deoxyadenosine (DX), and prostatic fluid (PROST) were added after thawing. Semen evaluations were performed using computer-assisted sperm analysis (CASA) at thawing and during 120min of incubation at 37 degrees C. Three experiments were conducted: 1) to establish which concentrations of stimulants work best; 2) to investigate the interaction between thawing rate and addition of CAF 5mM, PTX 2.5mM and PROST; 3) to evaluate the effect of PTX 7.5mM and DX 5mM on semen motility after thawing. In experiment 1, ALH and VCL were enhanced at thawing by CAF 7.5mM (CAF 7.5: 9.1+/-0.5microm; control: 6.7+/-0.4microm) and DX 5 and 7.5mM (DX 5: 199.1+/-12.8microm/s; DX 7.5: 197.3+/-13.9microm/s; control: 162.5+/-8.4microm/s), while PTX 2.5-5-7.5mM improved TOT after 120min of incubation. In experiment 2, PROST lowered ALH values throughout incubation (P<0.05) with respect to the other treatments, in particular when compared to CAF at Time=30 and at Time=60. In experiment 3, PTX 7.5mM improved VAP (PTX: 101.6+/-6.8microm/s; control: 81.9+/-10.5microm/s), VSL (PTX: 82.9+/-6.4microm/s; control: 65.9+/-9.8microm/s), VCL (PTX: 214.3+/-13.3microm/s; control:167+/-15.7microm/s), ALH (PTX: 10.5+/-0.3; control: 7.3+/-1.4microm), PM (PTX: 11.3+/-4.2%; control: 7.7+/-3.9%) and TOT (PTX: 20.1+/-5.3%; control:15.6+/-5.6%) at Time=120, while DX 5mM influenced VCL at Time=60 (DX: 218.3+/-14.3microm/s; control: 188.5+/-7.5microm/s, P<0.05). Motility stimulants may be useful for enhancing motility of canine frozen-thawed spermatozoa without affecting sperm longevity.

[Genuine adult unilateral glaucomas: true or false]. / Les vrais et les faux glaucomes unilatéraux de l'adulte.

The diagnosis of unilateral glaucoma essentially requires an etiologic investigation primarily to make sure that the deterioration is truly glaucomatous, thus specifically ruling out other optical neuropathies and papillary abnormality, such as tilted disc or drusen, which can mimic glaucomatous perimetric defects. Nonetheless, some apparent unilateral glaucomas can become bilateral later, as with primary open-angle glaucoma, though more frequently with primary closed-angle glaucoma in the absence of prophylaxis, and with exfoliative glaucoma. Genuine unilateral glaucomas concern the pigmentary glaucomas, the contusive glaucomas, the secondary closed-angle glaucomas, which encompass iridocorneoendothelial syndromes, ocular inflammations with opened angle, and glaucomas with an increase in the venous episcleral pressure.

Estimation of genetic parameters and genome scan for 15 semen characteristics traits of Holstein bulls.

A QTL detection experiment was performed in French dairy cattle to search for QTL related to male fertility. Ten families, involving a total of 515 bulls, were phenotyped for ejaculated volume and sperm concentration, number of spermatozoa, motility, velocity, percentage of motile spermatozoa after thawing and abnormal spermatozoa. A set of 148 microsatellite markers were used to realize a genome scan. First, genetic parameters were estimated for all traits. Semen production traits were found to have moderate heritabilities (from 0.15 to 0.30) while some of the semen quality traits such as motility had high heritabilities (close to 0.60). Genetic correlations among traits showed negative relationships between volume and concentration and between volume and most quality traits such as motility or abnormal sperm while correlations between concentration and these traits were rather favourable. Percentages of abnormal sperm were negatively related to quality traits, especially with motility and velocity of spermatozoa. Three QTL related to abnormal sperm frequencies were significant at p < 0.01. In total, 11 QTL (p < 0.05) were detected. However, the number of QTL detected was within the range of expected false positives. Because of the lack of power to find QTL in this design further analyses are required to confirm these QTL.

[Improving management of glaucoma's risk factors]. / Pour une meilleure gestion des facteurs de risqué du glaucome.

Lowering intra-ocular pressure is always a necessity to treat glaucoma. Others identified risks factors may be fought, with the hope to favourably act on the disease: arteriosclerosis worsening parameters, low diastolic arterial pressure, vasospastic or sleep apnea syndrome, inverse pupillary block in pigmentary dispersion. On the other hand, ignoring a noctural closure of the irido-corneal angle or a non-compliance to the medical treatment may lead to glaucoma worsening.

[News in trabeculoplasty]. / Actualités des trabéculoplasties.

The main objection to argon laser trabeculoplasty is collateral tissular injury, requiring hazardous repeated sessions if tonometric efficacy decreases. Selective trabeculoplasty could allow reliably effective iterative sessions because it is relatively harmless to tissues. Two other physical methods are on the market, although they are still being investigated, which also allow repeated treatments with minimal trabecular impairment. Titanium:sapphire laser trabeculoplasty consists of a very short pulse duration, with a wavelength penetrating deeply into the trabecula meshwork; the first results indicate similar intraocular pressure reduction as that obtained with argon trabeculoplasty and selective trabeculoplasty, but point out a possible risk of a paradoxical pressure rise during the days following the procedure. Pneumotrabeculoplasty is a procedure that uses ocular stretching by suction, which could finally provide a long-lasting decrease in intraocular pressure, less than that obtained with lasers, but its harmlessness is proved and its cost much lower.

[Satisfaction and compliance of ocular hypertensive and glaucoma patients topically treated with a combination therapy]. / Satisfaction et observance des patients présentant une hypertonie oculaire ou un glaucome à angle ouvert après instauration d'une bithérapie fixe.

OBJECTIVES: To evaluate satisfaction and compliance in glaucoma and ocular hypertensive patients receiving a fixed combination treatment. MATERIALS AND METHODS: After instilling a fixed combination, patients were asked to fill out a questionnaire about their satisfaction and compliance at baseline and 15 days after the onset of new therapy. RESULTS: 1693 glaucoma patients (G) and 621 ocular hypertensive (OHT) patients were included. Mean age was 65.6+/-11.7 years. Onset of disease was 7.2+/-6.6 years and 5.2+/-4.9 years for G and OHT patients, respectively. Insufficient efficacy of the previous topical treatment (monotherapy in 55% of cases) was the main cause for shifting to a fixed combination in 70% of cases. Satisfaction was increased in 15% of the patients and compliance was increased in 25% of the patients. DISCUSSION: Fixed combination provides an easier regimen and therefore encourages better compliance, a key issue in a chronic disease such as glaucoma.

[Clinical key points. Optic disk]. / Les points-clés de la clinique. La papille.

Five points should be evaluated during optic disc examination: the size of the optic disc, the condition of the neuroretinal rim, the presence of optic disc hemorrhages, the appearance of the retinal nerve fiber layer, and the comparison between the two discs.

Transient adverse effects of an attenuated bluetongue virus vaccine on the quality of ram semen.

This study investigated the effects of the vaccination of rams with a serotype 2 bluetongue virus vaccine on the quality of their semen. One group of 23 rams was vaccinated on days 0 and 47, and 23 rams were left unvaccinated. Samples of blood, serum and semen were collected regularly in order to detect the virus genome, and to compare the quality of the semen from the vaccinated and unvaccinated rams. Segment 10 of the genome of the vaccine strain was detected in the blood of the vaccinated animals by reverse transcriptase-PCR (RT-PCR) on days 7, 13 and 19 after the first vaccination, but no virus was isolated from the RT-PCR-positive blood or from any of the semen samples from the vaccinated animals. There was a significant decrease in the concentration and motility of the spermatozoa and an increase in the proportion of abnormal and dead spermatozoa after the first vaccination; however, after the second vaccination only smaller, non-significant changes were observed. On day 69, the quality of the semen of the vaccinated animals was not significantly different from that of the controls.

[Practical measures. When ocular hypertension is unilateral]. / Attitudes pratiques. Quand l'hypertension oculaire est unilatérale.

Certain causes of unilateral ocular hypertension (including glaucoma) are relatively frequent and/or can be problematic at the time of etiological diagnosis. Although the pseudo-exfoliative syndrome is often easily identified by the presence of typical whitish formations on the anterior crystalloid and by the atrophy of the pupillary margin of the iris, it can at times be difficult to recognize (use high magnification, pupillary dilatation, and gonioscopy). The diagnosis of pigmentary dispersion is classically based on the discovery of a Krükenberg spindle and iris transillumination, but these signs may be missing, and the diagnosis can only be made by observation of the anterior hyaloid angle. Questioning the patient can lead to the suspicion of an old ocular contusion, usually confirmed by thorough bilateral gonioscopic observation. Outside of crisis periods, Posner-Schlossman syndrome can only be strongly suspected by the persistence of very fine and rare retrocorneal precipitates visible on high magnification. Iridocorneal endothelial syndromes (causes of unilateral glaucoma by evolutive goniosynechia) affects women from 25 to 50 years of age with no notable antecedent; they evolve more or less rapidly and are expressed in three ways: essential atrophy of the iris and Cogan-Reese disease, with the anatomical features easily identified on the iris, while Chandler disease can only be confirmed by gonioscopy, high-magnification observation of the cornea, and corneal endothelial cell count and analysis.

[Prevalence and description of treatment with intraocular pressure-lowering topical medications in continental France]. / Prévalence et description du traitement par hypotonisants pour glaucome et hypertonie oculaire en France.

PURPOSE: The first objective of the present study was to estimate the prevalence of patients treated for glaucoma or ocular hypertension (OHT) with an IOP (intraocular pressure) -lowering topical medication. Subjects were 40 years old and living in continental France. The second objective was to describe the type of therapy, compliance, and the quality of life of the subjects treated. METHODS: This study was a telephone survey conducted in a general population on a representative sample of 5726 subjects in 2004. Subjects treated for glaucoma or OHT were defined as those declaring use of eye drops for more than 1 month and mentioning one of the 52 registered IOP-lowering topical medications and/or stating that they were taking eye drops for glaucoma or OHT. Quality of life was measured using the GlauQOL-17 questionnaire. RESULTS: 237 subjects (4.1%) corresponded to this definition. The prevalence increased with age, from 0.7% in subjects aged 40-44 years to 10.6% in those aged 80 years or more. The age-standardized prevalence was higher in the Paris area (5.3%), the Mediterranean (4.5%), and the Southwest (4.7%), and lower in rural areas (3.2%), and in subjects with less than high school education (2.9%). Beta-blockers (49.5%) and prostaglandins (37.4%) were the most frequent treatments, followed by carbonic anhydrase inhibitors (15.3%), sympathomimetics (5.7%), and myotics (1.3%). Compliance was not total in 39% of the patients (22% of those treated with once-a-day dosage). DISCUSSION: The results of the present study are in line with French health authority data and with the results of the French "Glaucoma and intraocular high pressure, one day" study results. Moreover, the lower prevalence in regions with low medical density, low socioeconomic level, and rural areas, suggest that glaucoma or OHT might be underdiagnosed. CONCLUSION: On the basis of this first nationwide study, it can be estimated that the prevalence of subjects treated with IOP-lowering topical medications is about 1.2 million in France. The number of daily doses appears to influence compliance.

[Practical assessment. Early-stage or advanced glaucoma]. / Bilan en pratique. Glaucome débutant ou avancé.

In the case of early-stage or advanced glaucoma, the major problem is no longer diagnostic, but evaluating its response to treatment. Other than questioning the patient, assessment includes measuring visual acuity and intraocular pressure, examining the anterior segment and the optic disc, and finally an analysis of the visual field. This latter examination remains the least contestable, although subjective, in evaluating how a confirmed case of glaucoma is evolving. Examination of the optic disc using stereoscopy should include a drawing or, at best, a photograph. Finally, three recent analyzers are available and being evaluated: HRT II, GDx, OCT-3. Depending on the results (of intraocular pressure, the visual field and the optic disk), treatment can be modified and/or the assessment completed.

Long term effect on IOP of a stainless steel glaucoma drainage implant (Ex-PRESS) in combined surgery with phacoemulsification.

AIM: To evaluate the efficacy and safety of a stainless steel miniature glaucoma drainage device (Ex-PRESS R50) for the surgical treatment of primary open angle glaucoma (POAG) and cataract when combined with phacoemulsification. METHODS: Clinical, prospective, multicentre, single treatment arm, non-randomised, non-masked study. The Ex-PRESS device was implanted at the limbus under a conjunctival flap. Phacoemulsification cataract extraction and in the bag IOL implantation were performed through clear cornea temporally. PRIMARY OUTCOME: IOP change; secondary outcomes: side effects and VA changes. RESULTS: 26 eyes of 25 patients were implanted with the device. The mean (SD) follow up was 23.9 (10.4) months and the mean age was 75.1 (7.1) years. 17/26 eyes have more than 3 years of follow up. One case was discontinued because of device removal, one because of death, and three were lost to follow up. EFFICACY: preoperative IOP was 21 (4) mm Hg; at 1, 2, and 3 years IOP was 15.3 (3.1) mm Hg (35% reduction), 16.6 (2.7) mm Hg (29% reduction), and 16 (2.6) mm Hg (22% reduction) respectively. Kaplan-Meyer determined overall success rate (IOP < or = 21 mm Hg at the last visit with or without medications) as 76.9%. The number of antiglaucoma medications was reduced by 95% at year 1. Only six patients (23%) were taking IOP lowering treatment at their last visit, five with one medication and one with two medications. Side effects: early postoperative complications were clinically mild and included six cases of hypotony (IOP <5 mm Hg), three cases of hyphaema (<2 mm) with no clinically significant further effects. Long term complications were two cases (7.7%) of device rotation (one treated by reposition) and three cases (11.5%) of conjunctival erosion at 2 and 3 years. CONCLUSIONS: The Ex-PRESS implant, combined with phacoemulsification cataract extraction, is clinically safe and effective, maintaining in the long term a large reduction in IOP and in the number of antiglaucoma medications.

[Angle closure mechanisms of glaucoma]. / Les mécanismes des glaucomes par fermeture de l'angle.

Glaucoma caused by primary closure of the iridocorneal angle accounts for half of the glaucoma cases in the world, 9 out of 10 in patients of Sino-Mongolian origin. The most frequent mechanism involved is anterior chamber angle blockage, but glaucoma can also be the result of a plateau iris structure, ciliary blockage, and exceptionally microphthalmos. Other than these forms, closure of the iridocorneal angle can be secondary to acquired iridopathies, or caused by crystallin anomalies or therapeutic interventions.

[Glaucoma and quality of life]. / Glaucome et qualité de vie.

Glaucoma is a serious ocular disorder potentially leading to blindness. Measuring the quality of life of patients with glaucoma is important because it makes it possible to evaluate the impact of the disease and its treatment on the patient's everyday life. Hitherto, this was done using generic scales, or those developed for other diseases; but no scale suitable for glaucoma was available. The recently developed GlauQOL scale is now available. We present the short version of this questionnaire adapted to individual use within an ophthalmology consultation setting.