Long-term results of Ahmed glaucoma valve implantation with/without intravitreal anti-VEGF injection in neovascular glaucoma patients.

PURPOSE: This study aimed to evaluate the efficacy of Ahmed glaucoma valve (AGV) implantation with or without anti-VEGF injections in neovascular glaucoma patients. MATERIALS AND METHODS: This single-center retrospective study assessed NVG patients who underwent AGV implantation with or without anti-VEGF injections. Demographic and clinical data, including ocular findings, intraocular pressure (IOP), visual acuity, and glaucoma medication count, were recorded preoperatively and postoperatively at one day, one month, and one year. The study included 35 patients. Group 1 consisted of 23 patients who received anti-VEGF injections before AGV surgery. Group 2, with 12 patients, had no anti-VEGF injections prior to surgery. Successful surgery was defined as IOP values between 6 and 21mmHg. The primary outcome was a 30% or more reduction in IOP. RESULTS: The groups displayed no significant difference in their demographic or clinical profiles (P>0.05). The visual acuity before and one year after surgery did not differ significantly between the groups. However, IOP values significantly decreased by the end of the one-year follow-up for both groups. No significant differences were found between the groups regarding visual acuity, IOP, or the number of medications during the one-year follow-up (P>0.05). Success rates were 95.7% for Group 1 and 91.7% for Group 2. No significant difference in complications between the groups was observed (P>0.05). CONCLUSION: Anti-VEGF injections prior to AGV implantation did not significantly impact visual acuity, IOP values, or medication count during the one-year follow-up.

[Peripheral arterial disease in black African diabetics: epidemioclinical, ultrasonographic profile and determining factors]. / Artériopathie oblitérante des membres inférieurs chez le sujet diabétique noir africain : profil épidémioclinique, ultrasonographique et facteurs déterminants.

BACKGROUND: Diabetes can lead to micro and macro-angiopathies. The peripheral arterial disease (PAD) is a serious and an incapacitating disease. It is still under-estimated and under-treated throughout the world, particularly in sub-Saharan Africa. Doppler ultrasound, and in particular ankle brachial index (ABI), can be used to detect it. The aim was to determine the prevalence of PAD to study the clinical and ultrasonographic aspects and to identify the determining factors. PATIENTS AND METHODS: This was a descriptive and analytical study over a period of 5 years, including a total of 782 diabetic patients hospitalised in the diabetology department of the CHU la Reference Nationale. RESULTS: Among the 782 patients, 166 (21.2%) had an ABI < 0.9 reflected the PAD and 72 (9.2%) had an ABI > 1.3, suggestive of mediacalcosis. PAD of the lower limb was mild in 102 patients (61.4%), moderate in (26.3%) and severe in (12.3%). The mean age of the arteritic patients was 56.4 ± 10.2 years. Male gender predominated (59.6%) with a sex ratio of 1.6. All patients had type 2 diabetes (100%). The mean duration of diabetes was 13 ± 5.9 years. The majority of our patients with arterial disease had diabetes for at least 10 years (54.2%). The other cardiovascular in this population were obesity (45.2%), followed by hypertension and dyslipidaemia (32.5%). Diabetes was unbalanced (HbA ≥7%) in the majority of cases (75.3%). Clinically, the majority of patients had a trophic disorder (68%). Asymptomatic patients accounted for 24.6% of cases and those with intermittent claudication for 7.4%. Duplex doppler of the lower limbs showed that all patients with PAD had atheromatous lesions. The distal location was predominantly in the tibial arteries (54.8%). The determinants of PAD in this diabetic population were hypertension (p = 0.01) and obesity (p = 0.01). CONCLUSION: In our series, PAD was often discovered at an advanced stage, with a non-negligible prevalence. The determining factors found were hypertension and obesity. Screening and control of major cardiovascular risk factors is a priority in the management of this disease.

Full sample analysis of cerebral venous sinus thrombosis in ophthalmology inpatients.

PURPOSE: We hope that by analyzing the clinical features of cerebral venous sinus thrombosis (CVST), we can help ophthalmologists reduce misdiagnosis or delayed diagnosis. DESIGN: We evaluated 47 patients with CVST in terms of clinical manifestations. METHODS: All cases were analyzed in terms of risk factors, clinical symptoms, ophthalmic examination, imaging examination and lumbar puncture. RESULTS: The body mass indices (BMIs) of 41 patients (87.2%; 95% CI, 77.7-96.8%) were≥24, which is overweight by Chinese standards. There were 22 patients (46.8%; 95% CI, 32.5-61.1%) with BMIs≥28, who were considered obese. Thirteen were hypertensive (27.7%; 95% CI, 14.9-40.5%). The initial symptoms included blurred vision (23, 48.9%; 95% CI, 34.6-63.2%), amaurosis fugax (13, 27.7%; 95% CI, 14.9-40.5%), headache (11 patients, 23.4%; 95% CI, 11.3-35.5%), dizziness (3, 6.4%; 95% CI, -0.6-13.4%), and bilateral diplopia (3, 6.4%; 95% CI, -0.6-13.4%). There were 9 patients (9, 19.2%; 95% CI, 7.9-30.4%) with blindness, 23 patients (48.9%; 95% CI, 34.6-63.2%) with pupillary abnormalities, and 40 patients (85.1%; 95% CI, 74.9-95.2%) with papilledema. Forty-three of the 45 patients who successfully underwent a routine lumbar puncture showed high intracranial pressure (91.7%; 95.6% CI, 89.6-101.6%). Finally, two cases are reported in greater detail for illustrative purposes. CONCLUSION: The main reasons interfering with the diagnosis of CVST might be its nonspecific ocular symptoms and the physicians' clinical thought process being limited to the scope of common ophthalmological diseases.

[Effet blouse blanche résiduel : un outil pertinent en soins premiers?] / Office white-coat effect tail: A useful tool in family practice?

BACKGROUND: White coat effect (WCE) and white coat hypertension (WCH) are hardly both compared in primary care. OBJECTIVE: To assess the usefulness of repeated measures of systolic blood pressure (SBP) to dissociate various forms of white-coat interactions. METHODS: An open cross-sectional study on consecutive patients treated or not for high blood pressure was made in family physicians' offices. SBP was measured 5 times by an electronic device. Measurements were performed before (SBP1) and after (SBP5) the office visit by a lay assistant and at the beginning (SBP2), middle (SBP3) and end (SBP4) of visit, by the family physician. Home BP (HBPM) was measured from 3 consecutive days by the patient. WCE and office WCE tail (OWCET) were defined, respectively, as a 10 mmHg SBP increase or decrease between SBP2-SBP1 or SBP4-SBP2. WCH was considered when HBPM was normal (SBP < 135 mmHg) at home and high during the SBP2 office visit. RESULTS: Two hundred five patients (134 women versus 71 men, ratio 1.9, aged 59.8±15.7 years) were recruited. In categorical terms, there were 51 patients (25%) who presented with WCE, OWCET was seen in 121 patients (62%) and 47 patients (23%) had WCH. Only 36 patients (18%) presented both OWCET and WCE and 32 (16%) had both OWCET and WCH. The receiver operating characteristic curves (ROCs) of OWCET in diagnosing WCE or WCH were respectively 0.67 (p<0.0001) and 0.53 (NS). CONCLUSION: Thus, OWCET was predictive of WCE and not of WCH and it is worthwhile to be measured in the family physician office.

Intraoperative iStent versus postoperative selective laser trabeculoplasty in early glaucoma patients undergoing cataract surgery: A retrospective comparative study.

PURPOSE: To compare the efficacy and safety of iStent inject® versus 360° selective laser trabeculoplasty (SLT) in patients with early glaucoma undergoing cataract surgery. METHODS: A retrospective non-randomized study was conducted in 73 eyes divided into two groups: cataract surgery+intraoperative iStent (n=40) versus cataract surgery+postoperative SLT at one month (n=33). The primary endpoint was intraocular pressure (IOP) lowering≥20% between baseline and 6 months postoperatively. The secondary endpoints were IOP lowering at 1, 6 and 12 months, and the mean number of IOP-lowering medications at 6 and 12 months. RESULTS: The mean baseline IOP was 19.1 mmHg with no significant difference between groups. The mean baseline number of IOP-lowering medications was higher in the iStent group (n=1.95) compared to the SLT group (n=1.53; P=0.04). At 6 months, 18 (60%) patients in the SLT group and 20 (51%) patients in the iStent group achieved IOP lowering≥20% with no significant difference between groups (P=0.431). At 6 months, no difference in the mean number of IOP-lowering medications was found between groups (-0.92 and -0.89 in the iStent and SLT groups, respectively). Similar results were found at 12 months. CONCLUSION: These results suggest similar safety and efficacy of intraoperative iStent and postoperative 360° SLT in lowering IOP and reducing glaucoma eye drops in early glaucoma patients undergoing cataract surgery. Treatment choice should be based on the ophthalmologist's experience and on the cost-benefit ratio.

[Local administration of amphotericin B by VAC instillation: Therapeutic aid in the treatment of mucormycosis]. / Application locale d'amphotéricine B par VAC instillation : aide thérapeutique dans le traitement de la mucormycose.

Mucormycosis is a rare and serious fungal infection, occurring mainly in immunocompromised, diabetic, polytrauma or burn patients. Current standard treatments include iterative carcinological surgical trimming, systemic treatment with liposomal amphotericin B and second-line Posaconazole or Isavuconazole. We report the case of a 37-year-old female patient with no previous medical history who developed a disseminated mucormycosis, with an estimated 25 % loss of skin substance and major decay of the chest wall. In addition to standard treatment, local instillations of amphotericin B using the VAC Veraflow® system were performed. We believe that local instillations of amphotericin B by VAC could improve the functional prognosis of patients with skin involvement.

Effect of bimatoprost sustained-release intracameral implant on intraocular pressure and medication burden in patients with prior glaucoma surgery.

The present retrospective study evaluated intraocular pressure (IOP) and medication burden after bimatoprost sustained-release (bimatoprost SR, Durysta, Allergan) implantation in patients with glaucoma. A secondary objective was to examine an effect of bimatoprost SR in a subset of patients with prior minimally invasive and incisional glaucoma surgery. A retrospective chart review of 122 eyes that received bimatoprost SR by 6 glaucoma specialists at Wills Eye Hospital between March 2020 and September 2021 was performed. One hundred and eighteen eyes from 84 patients had a reduction in IOP (18.5±5.7mmHg vs. 16.0±5.4mmHg, P<0.01) and required fewer glaucoma medications (2.1±1.4 vs. 1.2±1.2, P<0.01) after bimatoprost SR implantation. In 41 eyes from 31 patients who previously underwent glaucoma surgery (including iStent, goniotomy, trabeculectomy, Xen Gel Stent, or tube shunt surgery), medication burden was decreased after bimatoprost SR implantation (1.9±1.3 vs. 1.0±1.0, P<0.001). These data suggest that bimatoprost SR is an efficacious treatment modality for glaucoma, even in post-surgical patients.

A Non-Coding Fc Gamma Receptor Cis-Regulatory Variant within the 1q23 Gene Cluster Is Associated with Plasmodium falciparum Infection in Children Residing in Burkina Faso.

Antibodies play a crucial role in activating protective immunity against malaria by interacting with Fc-gamma receptors (FcγRs). Genetic variations in genes encoding FcγRs can affect immune cell responses to the parasite. In this study, our aim was to investigate whether non-coding variants that regulate FcγR expression could influence the prevalence of Plasmodium falciparum infection. Through bioinformatics approaches, we selected expression quantitative trait loci (eQTL) for FCGR2A, FCGR2B, FCGR2C, FCGR3A, and FCGR3B genes encoding FcγRs (FCGR), in whole blood. We prioritized two regulatory variants, rs2099684 and rs1771575, located in open genomic regions. These variants were identified using RegVar, ImmuNexUT, and transcription factor annotations specific to immune cells. In addition to these, we genotyped the coding variants FCGR2A/rs1801274 and FCGR2B/rs1050501 in 234 individuals from a malaria-endemic area in Burkina Faso. We conducted age and family-based analyses to evaluate associations with the prevalence of malarial infection in both children and adults. The analysis revealed that the regulatory rs1771575-CC genotype was predicted to influence FCGR2B/FCGR2C/FCGR3A transcripts in immune cells and was the sole variant associated with a higher prevalence of malarial infection in children. In conclusion, this study identifies the rs1771575 cis-regulatory variant affecting several FcγRs in myeloid and neutrophil cells and associates it with the inter-individual capacity of children living in Burkina Faso to control malarial infection.

[Biomechanics of the lamina cribrosa: A determining factor in glaucomatous neuropathy. A review of the literature]. / Biomécanique de la lame criblée : un facteur déterminant de la neuropathie glaucomateuse. Une revue de la littérature.

Glaucoma is a chronic optic neuropathy characterized by progressive sclero-laminar remodeling. The main factor at the origin of these deformations is the intraocular pressure (IOP), the effect of which varies according to the biomechanical properties of the individual lamina cribrosa (LC). In this environment, the LC represents a malleable zone of weakness within a rigid corneoscleral shell. It is a dynamic structure whose movements play a key role in the pathogenesis of glaucoma: displacing it posteriorly, in addition to contributing to the characteristic appearance of glaucomatous cupping, would increase constriction on the nerve fibers and the laminar capillaries. Often incorrectly considered permanent in adults, these deformations have a certain degree of reversibility, which is currently better characterized thanks to progress in imaging techniques. The occurrence of anterior displacement and laminar thickening following a reduction in IOP could thus constitute a good prognostic factor by reducing mechanical stress on this region. These changes would tend to reduce laminar pore tortuosity and shear forces, which are probably key mechanisms of axonal loss in glaucoma.

[Study of arterial pressure levels at consultation in treated hypertensive Algerian patients]. / Étude du niveau de pression artérielle en consultation chez l'hypertendu algérien traité (PACT II).

BACKGROUND: Hypertension is responsible for 8.5 million deaths from stroke, ischemic heart disease and other vascular and kidney diseases. In Algeria, hypertension (HTN) is the most common chronic disease with an estimated prevalence of 23,6%. METHODS: The PACT II study is a national, observational, descriptive, cross-sectional, multicenter and non-interventional study of therapeutic strategy, conducted in Algeria on hypertensive patients treated for at least 3 months, followed by 100 specialists or general practitioners. The primary objective is to describe the hypertension management in Algeria through the distribution of patients treated for HTN through predefined levels of arterial pressure (AP) reached under treatment. RESULTS: 2000 eligible patients were recruited in the study. 63.5% and 36.4% of patients were female and male respectively. The average age was 62.4 years ± 10.7. The most affected age group (65.2%) was between 55 to 75 years old. Most of the patients had an elevated blood pressure (BP) with 49.30 % at level III AP (130 - 139 mmHg of SBP or 80 - 89 mmHg of DBP), with 49.6% for diabetic patients and 48.8% for non-diabetic patients, then followed by 20.35% at the level IV AP (140 - 159 mmHg of SBP or 90 - 99 mmHg of DBP) with 21.4% for diabetic and 18.3% for non-diabetic patients. Also, 47.32% were at AP level III in patients with Renal failure. Regarding the achievement of the BP target, it was 17.4% for the overall population with 18,3% for diabetic's patients and only 12.64% for Renal failure patients. Additionally, the risk of cardiovascular disease (CVD) was at very high level for most patients, corresponding to 38,4 % of the overall study population. At last, PACT II study data were collected on analysis of blood pressure levels in the overall population and in cardiovascular risk (CVR) population groups such as diabetes (65%), sedentary lifestyle (53%), dyslipidemia (50%), obesity (44%), and renal failure (11.3%). CONCLUSION: PACT II has made it possible to update national data relating to hypertension in Algeria. It confirmed the low level of achievement of the BP target, even if the average arterial pressure level obtained was acceptable in 76% patients with a BP level which was lower than 140 mmHg for SBP and less than 90 mmHg for DBP. Many efforts must be made, according to WHO recommendations, to improve the management of hypertensive patients and BP control in Algeria.

Comparison of the iCare rebound tonometer and the Perkins applanation tonometer in children under general anesthesia.

INTRODUCTION: The goal of the study was to compare Perkins applanation tonometry and iCare rebound tonometry, evaluating their correlation and agreement in a diverse pediatric population under general anaesthesia (GA). MATERIALS AND METHODS: Children undergoing an eye examination under GA between November 2019 and March 2020 were included. Intraocular pressure (IOP) was measured successively using the Perkins applanation tonometer and the iCare IC200 rebound tonometer. Ultrasonic central pachymetry and axial length were measured. RESULTS: One hundred and thirty-eight eyes of 72 children were included. The mean age was 2.87years. IOP measurements obtained with the two tonometers were statistically and significantly highly correlated (r=0.8, P<0.001), although the iCare overestimated IOP by an average of 3.37mmHg (SD±4.48). The agreement between the two methods was moderate; the 95% agreement limits ranged from -5.41 to +12.15mmHg (r=0.5, P<0.001). The IOP difference between the two tonometers was weakly but significantly correlated with mean IOP (r=0.52; P=0.006). No correlation was found with axial length and pachymetry. CONCLUSION: In this study, the IOP values obtained using the Perkins applanation tonometer and the iCare IC200 rebound tonometer were well correlated. The iCare tended to overestimate the IOP, especially for high IOP values. However, no underestimation of IOP was found with this device, hence its potential for glaucoma screening in children.

[Hypertension: Who to treat, to what extent and how?] / Hypertension artérielle : qui traiter, jusqu'où et comment ?

Hypertension is the modifiable risk factor causing the largest loss in healthy life-years. The risk of cardiovascular events increases exponentially with the level of blood pressure (BP), starting from 115mmHg for systolic BP. Out-of-office BP measurements (self-measurements or ambulatory BP measurements) are now preferred for the diagnosis and follow up. In the absence of a preferred indication, antihypertensive treatment is based on thiazide diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. These treatments are associated with a significant reduction in morbidity and mortality in people with office BP ≥ 140/90mmHg (self-measurements ≥ 135/85mmHg). For people at high cardiovascular risk, especially those with a history of cardiovascular disease, starting the treatment for an office BP ≥ 130/80mmHg is also beneficial (self-measurements ≥ 130/80mmHg as well). It is now common to start treatment with half-dose dual therapy, which is more effective and better tolerated than full-dose monotherapy. The clinical effect is assessed at 4 weeks and intensification, if required, is then usually done by switching to the same dual therapy at full-dose for both components.

Gelatin implant in the treatment of open-angle glaucoma: Safety and efficacy in real-life conditions.

OBJECTIVE: To evaluate the safety and efficacy of the Xen® implant for the treatment of open-angle glaucoma. MATERIAL AND METHOD: Retrospective study including patients who received the Xen® implant between January 2019 and December 2020 in a university hospital. Demographic and medical data were collected using DxCare® software. The primary endpoint was a 20% reduction in intraocular pressure (IOP) at 12 months according to Société Française du Glaucome (SFG) recommendations. The secondary endpoints were decrease in glaucoma medications and incidence of adverse events. RESULTS: Fifty-three patients (65 eyes) were included (sex ratio 0.65, age 75.38±7.31 years). IOP decreased by 18.51% from 17.86±4.22mmHg to 14.55±2.66mmHg (P<0.05). The number of glaucoma medications was 2.16±1.01 preoperatively vs 0.49±0.94 postoperatively (P<0.05). Adverse events included 8 malpositionings, 3 of which required reoperation, 1 case of increased IOP resolved by trabeculectomy, 1 case of venous ischemia treated by photocoagulation, 3 choroidal detachments and 3 corneal ulcers. Needling was required for 18 eyes. CONCLUSION: At 12 months, the IOP was lower than previously reported in the literature (14.55 vs 15.90mmHg, P<0.05), probably due to a lower preoperative IOP. The number of postoperative medications was similar to the literature (0.49 vs 0.40, P=0.51), as was the frequency of needling (27.69% vs 32.00%, P=0.36). The frequency of malpositioning was higher (12.31% vs 7.70%, P<0.05), probably due to the management of complicated patients. The efficacy of Xen® was in line with recommendations. It would be interesting to compare the efficacy of Xen® with trabeculectomy.

Smoothelin-like 1 knockout mice display sex-dependent alterations in blood flow and cardiac function.

Smoothelin-like 1 (SMTNL1) modulates the contractile performance of smooth muscle and thus has a key role in vascular homeostasis. Elevated vascular tone, recognized as a contributor to the development of progressive cardiac dysfunction, was previously found with SMTNL1 deletion. In this study, we assessed cardiac morphology and function of male and female, wild-type (Smtnl1+/+) and global SMTNL1 knockout (Smtnl1-/-) mice at 10 weeks of age. Gross dissection revealed distinct cardiac morphology only in males; Smtnl1-/- hearts were significantly smaller than Smtnl1+/+, but the left ventricle (LV) proportion of heart mass was greater. Male Smtnl1-/- mice also displayed increased ejection fraction and fractional shortening, as well as elevated aortic and pulmonary flow velocities. The impact of cardiac stress with pressure overload by transverse aortic constriction (TAC) was examined in male mice. With TAC banding, systolic function was preserved, but the LV filling pressure was selectively elevated due to relaxation impairment. Smtnl1-/- mice displayed higher early/passive filling velocity of LV/early mitral annulus velocity ratio (E/E' ratio) and myocardial performance index along with a prolonged isovolumetric relaxation time. Taken together, the findings support a novel, sex-dimorphic role for SMTNL1 in modulating cardiac structure and function of mice.

Closed-Incision and Surrounding Soft Tissue Negative Pressure Dressings in Post-Mastectomy Pre-Pectoral Direct-to-Implant Breast Reconstruction: A Pilot Study.

Background: Closed-incision and surrounding soft tissue negative pressure therapy (cistNPT) is theorized to decrease infection, reduce tissue edema, and promote healing of the mastectomy skin flap. We report our early experience with this dressing in pre-pectoral direct-to-implant (pDTI) breast reconstruction. Methods: We retrospectively reviewed all patients who underwent post-mastectomy pDTI breast reconstruction with cistNPT between July 2019 and February 2020. All reconstructions utilized smooth round silicone gel implants and human acellular dermal matrix. Results: Thirty-five female patients underwent 58 mastectomies. Mean age and body mass index were 49.9 years and 28.9 kg/m2, respectively. Eleven (31.4%) patients had neoadjuvant chemotherapy. The mean sternal notch-to-nipple distance was 27.0 cm. The median specimen weight was 483 g, while the median implant volume was 495 cc. The mean implant-to-specimen ratio was 1.4 for nipple-sparing, 1.1 for skin-sparing, and 0.7 for skin-reducing mastectomy. Total drain volume was 483.1 cc from each breast. Post-operative complications included seroma (5.2%), peri-incisional necrosis (8.6%), and superficial skin epidermolysis (13.8%). There were no cases of surgical site infection, dehiscence, or hematoma. Rate of return to the operative room was 3.4%. Mean follow-up was 90 days. Conclusions: In our series of pDTI breast reconstructions with cistNPT, no patients experienced hematoma, dehiscence, or infection complications. Rates of seroma, skin necrosis requiring operative debridement, and total drain volumes were lower than those reported in literature.

Contexte: La thérapie par pression négative des incisions fermées et des tissus mous environnants (cistNPT) doit théoriquement diminuer l'infection, réduire l'œdème tissulaire et faciliter la guérison du lambeau cutané de mastectomie. Nous fournissons notre première expérience avec ce pansement de reconstruction mammaire prépectorale directe à l'implant (pDTI). Méthodes: Nous avons revu rétrospectivement toutes les patientes ayant subi une reconstruction mammaire pDTI post mastectomie entre juillet 2019 et février 2020. Toutes les reconstructions ont utilisé des implants en gel de silicone lisses et ronds avec une matrice dermique acellulaire humaine. Résultats: Trente-cinq femmes ont subi 58 mastectomies. L'âge moyen était de 49,9 ans et l'IMC moyen de 28,9 kg/m2. Onze patientes (31,4 %) recevaient une chimiothérapie néoadjuvante. La distance moyenne du sommet du manubrium sternal au mamelon était de 27,0 cm. Le poids médian de l'échantillon était de 483 g tandis que le volume médian de l'implant était de 495 cc. Le rapport moyen implant/échantillon était de 1,4 pour la préservation du mamelon, 1,1 pour la préservation de la peau et de 0,7 pour la mastectomie de réduction cutanée. Le volume total de drainage de chaque sein a été de 483,1 cc. Les complications postopératoires ont été, notamment, un sérome (5,2 %), une nécrose péri-incision (8,6 %) et une épidermolyse superficielle de la peau (13,8 %). Il n'y a pas eu de cas d'infection du site chirurgical, de déhiscence ou d'hématome. Le taux de reprise chirurgicale a été de 3,4 %. Le suivi moyen a été de 90 jours. Conclusions: Dans notre série de reconstructions du sein par pDTI, aucune patiente n'a eu d'hématome, de déhiscence ou de complication infectieuse. Les taux de sérome, de nécrose cutanée nécessitant un débridement chirurgical et les volumes totaux de drainage étaient inférieurs aux chiffres publiés.

Tono-pen and Schiotz tonometer measurements in gas-filled eyes.

PURPOSE: This study aims to assess the difference between Tono-Pen and Schiotz tonometer measurements in gas-filled eyes and to create a nomogram and equation which can be used to estimate actual intraocular pressure in order to provide a safe IOP level at the end of the surgery. METHODS: Twenty-two eyes that underwent pars plana vitrectomy were included in the study. Perioperative Tono-Pen and Schiotz tonometer measurements were performed when the eyes were filled with air in the setting of certain vitrectomy infusion pressure levels. Measurements were performed when the eyes were filled with fluid to test the accuracy of the systems. The mean value of the Tono-Pen and Schiotz readings in air-filled eyes corresponding to certain actual intraocular pressure levels were analyzed to create nomograms. RESULTS: Both Tono-Pen and Schiotz tonometers underestimated the actual intraocular pressure set on the screen of the vitrectomy system in the air-filled eyes. The Tono-Pen deviation was 4.5mmHg at a level of 15mmHg actual intraocular pressure, and 16.9mmHg at a level of 55mmHg actual intraocular pressure. The Schiotz tonometer deviation was 10mmHg at a level of 15mmHg actual intraocular pressure, and 8.9mmHg at a level of 55mmHg actual intraocular pressure. All the mean differences between tonometer readings and actual intraocular pressure were statistically significant. (P<0.001) CONCLUSION: To achieve an adequate and safe tamponade at an actual IOP range of 20 - 25mmHg, one should adjust the IOP with Schiotz readings to a level of 9-12mmHg, or Tono-Pen readings to 12-18mmHg.

[Is pressure transmission quality during cystometry dependent on the type of effort?] / La qualité de transmission des pressions pendant la cystomanométrie est-elle dépendante du type d'effort ?

INTRODUCTION: The International Continence Society (ICS) recommends a control of the good pressure transmission by a coughing effort during cystometry. While poor transmission is sometimes observed in routine practice, other maneuvers can also be proposed. The main objective of this study was to determine if there is a better maneuver to evaluate the pressure transmission ratio between the abdominal cavity and the bladder. METHODS: We performed a prospective, consecutive, single-center study in a tertiary neuro-urology department in 31 subjects. During a cystometry, each patient was asked to perform at 0ml and 100ml of bladder filling, a cough effort, an abdominal push and a Valsalva maneuver controlled by a manometer. The value of the bladder pressure to abdominal pressure ratio was collected manually. The average variations were compared between each maneuver for the same volume of replenishment and between the 2 volumes of replenishment studied. RESULTS: At 0ml of filling, the difference in pressure variation between the Pves and the Pabd is significantly higher during the cough maneuver compared to the Valsalva (P=0.015), which is not found at 100ml of filling. CONCLUSION: During bladder filling, the pressure transmission ratios during the 3 maneuvers are equivalent. Coughing or abdominal thrusting, which are easier to perform than the Valsalva maneuver, should be recommended to check the quality of the recording during cystomanometry.

Ocular findings in patients with vitiligo: A single-center experience.

PURPOSE: We sought to evaluate ocular abnormalities in patients with nonsegmental vitiligo. METHODS: This was a case-control study in which patients with vitiligo were evaluated in terms of ocular findings. Vitiligo patients were classified into acrofacial and generalized groups. Duration and periocular involvement of the vitiligo were recorded. Vitiligo Area Scoring Index (VASI) and Vitiligo Disease Activity Score (VIDA) were calculated. All patients and control subjects underwent uncorrected and corrected visual acuity, keratometry, central corneal thickness, Schirmer's testing, tear film break-up time (TBUT), intraocular pressure, biomicroscopic examination, and anterior segment tomography. RESULTS: A total of 244 subjects (130 vitiligo and 114 controls) were included in the study. Most of the vitiligo patients (87.7%) had vitiligo vulgaris. One-third of all vitiligo patients had periocular involvement. Fundus hypopigmentation was found in 42.6% of the vitiligo patients. Thirty-five vitiligo patients (27.3%) and 23 vitiligo patients (18%) had moderately severe and very severe dry eyes, respectively. Based on TBUT, 48 vitiligo patients (44.4%) had a poor tear film. Median scores on Schirmer's testing were 5mm in vitiligo patients with periocular involvement and 11mm in vitiligo patients without periocular involvement (P<0.001). Mean intraocular pressure was 14.4±3.2mmHg in vitiligo patients and was no different from that of the control subjects. Six patients (4.6%) had increased IOP. None of the control subjects had increased IOP. Corneal keratometry showed a significantly higher vertical measurement in vitiligo patients. Astigmatism was significantly higher and peripheral iris atrophy was significantly more frequent in vitiligo patients compared to controls. CONCLUSION: Periocular involvement was associated with an increased risk of dry eye in vitiligo patients.

[XEN 45® gel stent implantation in glaucoma surgery: Dual-center comparative study between steroid-induced glaucoma and primary open angle glaucoma]. / Implantation du dispositif XEN 45® dans la chirurgie du glaucome : étude bicentrique bispective s'intéressant au glaucome cortisonique par rapport au glaucome primitif à angle ouvert.

INTRODUCTION: XEN 45® gel stent is an ab interno aqueous humor drainage device indicated for moderate glaucoma refractory to medical management. Its efficacy has been demonstrated in primary open-angle glaucoma (POAG). However, there are few studies on secondary glaucoma, including steroid-induced glaucoma (CG), defined as optic neuropathy induced by using local or systemic corticosteroids without increased flare. METHODS: We conducted a dual-center comparative cohort study between April 2019 and January 2021. 66 operated eyes were included, divided into two groups: POAG (56 eyes) and GC (10 eyes). The primary endpoint was the relative reduction in intraocular pressure (IOP) at three months postoperatively in the GC group. Three outcomes were defined: total success, partial success and failure. RESULTS: The total success rate was 100% in the GC group and 42.6% in the POAG group. Preoperative IOP was 36.1±9.1mmHg and 19.0±7.3mmHg respectively. IOP reduction was 69.1±11.7% in the GC group and 21.8±30.3% in the POAG group. Patients were younger in the GC group (49.3±21.2 versus 71.1±8.4 years), and preoperative conjunctival preparation was longer in this group (12 versus 5 weeks). The needling rate was 17.9% in the POAG group and 10% in the GC group. CONCLUSION: The XEN 45® gel stent is effective in the treatment of steroid-induced glaucoma. Further studies will be required to identify predictive factors for success and to establish criteria for good candidacy.

Decreased Diastolic Blood Pressure and Average Grip Strength in Adults With Type 1 Diabetes Compared With Controls: An Analysis of Data From the Canadian Longitudinal Study on Aging.

OBJECTIVES: Our aim in this study was to determine whether aging individuals with type 1 diabetes (T1D) have differences in cardiovascular health, assessed by blood pressure, and skeletal muscle function, assessed by grip strength, compared with matched nondiabetic controls (CON). METHODS: This investigation was a retrospective cohort analysis using baseline and 3-year follow-up data from the Canadian Longitudinal Study on Aging. Bivariate and multivariate regression analyses were used to examine the association between sociodemographic, health, behavioural and T1D-specific variables on blood pressure and grip strength in T1D and CON groups. Generalized estimating equations were used to model the average population changes in blood pressure and grip strength from baseline to follow up. RESULTS: The sample included 126 individuals (63 T1D and 63 CON). Systolic blood pressure was not significantly different between groups at baseline or follow up (p>0.05). However, compared with CON, diastolic blood pressure was significantly lower at both time-points in the T1D group (p<0.001). Grip strength was consistently lower among persons with T1D (p=0.03). In the multivariate regression model, body mass index, age and sex were significantly associated with diastolic blood pressure and grip strength in both groups. In the T1D group, disease duration accounted for a large proportion of the variance in diastolic blood pressure and grip strength (17% and 9%, respectively). The rate of decline in diastolic blood pressure and grip strength did not differ between groups (p>0.05). CONCLUSIONS: Diastolic blood pressure and grip strength appear to be consistently lower and differentially regulated in individuals with T1D vs CON. Aging individuals with T1D may be at risk of premature morbidity and mortality.