[Treatment of glaucoma]. / Le traitement du glaucoma.

Glaucoma is a group of chronic and evolutive optic neuropathies. It is caracterised by a progressive loss of optic nerve cells with specific modifications of the optic nerve head and of the visual field. A high intraocular pressure is one of the main risk factors. Thereby, the aim of glaucoma treatment is to reduce the intraocular pressure by medical, physical and/or surgical means. Eyedrops are used as initial treatment. As the most effective drops, prostaglandin analogs are the first-line therapy and have only few systemic side effects. Beta-blockers, local carbonic anhydrase inhibitors and alpha-agonists are the other most employed glaucoma drugs. Pilocarpine, acetazolamide and hyperosmotic agents are used in specific cases. Fixed combinations improve the compliance and the quality of life of patients who need several eyedrops. Preservative-free drops reduce ocular toxicity and improve the compliance of the patients. Trabeculoplasty or trabeculectomy are usefull in case of non response on ocular drops, or if the target pressure is not reached, or when dealing with toxicity or compliance matters. Nevertheless, the first procedure has a time-limited efficiency and the second-one exposes the patient to common surgery-related complications. Therefore, despite good results, they are rarely proposed as first-line therapy.

Effect of topical corneal anaesthesia on ocular response analyzer parameters: pilot study.

PURPOSE: The effect of topical corneal anaesthesia on corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal compensated IOP (IOPcc) was measured by ocular response analyzer (ORA). DESIGN: Observational, cross-sectional study. METHOD: We examined both eyes of 23 healthy volunteers. Patients with external eye disease, previous refractive surgery, contact lenses or topical medication were excluded. ORA parameters were first measured in both eyes. Oxybuprocaïne 0.4% eye drop was instilled in the right eyes (RE) and physiologic saline in the left eyes (LE) as a control to rule out the lubrication effect. After 2 min, the ORA measurements were performed again. Goldmann applanation tonometry (GAT) was finally done. Data are expressed as mean +/- standard deviation (SD). The medians of the four CH, CRF, IOPg, and IOPcc values measured before and after instillation were compared by using Wilcoxon signed ranks tests for RE and LE. RESULTS: The mean age was 39.5 +/- 11.6 years. The mean GAT was 13.1 +/- 2.5 mmHg for RE and 12.8 +/- 2.5 mmHg for LE. In the RE, the respective values for the two sequences were IOPcc = 15.6 +/- 2.6 mmHg and 15 +/- 2.8 mmHg (P = 0.036); IOPg = 15.3 +/- 3.3 mmHg and 15.4 +/- 3.5 mmHg (P = 0.806); CH = 11 +/- 1.3 mmHg and 11.1 +/- 1.4 mmHg (P = 0.563); CRF = 11.1 +/- 1.8 mmHg and 10.9 +/- 1.9 mmHg (P = 0.053). In the LE, the respective values for the two sequences were IOPcc = 15.4 +/- 2.6 mmHg and 15.6 +/- 2.8 mmHg (P = 0.903); IOPg = 15.5 +/- 3.5 mmHg and 15.4 +/- 3.4 mmHg (P = 0.208); CH = 10.8 +/- 1.4 mmHg and 10.7 +/- 1.7 mmHg (P = 0.494); CRF = 10.7 +/- 1.8 mmHg and 10.7 +/- 2.2 mmHg (P = 0.626). CONCLUSION: Two minutes after instillation, topical corneal anaesthetic slightly decreases IOPcc and also-but not statistically significantly-CRF. We did not find any statistical significant difference in CH or IOPg before and after topical corneal anaesthesia. Further investigation with more patients should be advised.

[Ocular side effects of glaucoma treatment agents]. / Les effets secondaires des antiglaucomateux.

Antiglaucomatous ocular side effects can be divided into specific and non specific ones. Non specific ocular side effects are mainly caused by preservative agents; they are essentially external ocular irritations. Specific ocular side effects are strongly related to the mechanism of action of the drug. These specific ocular side effects are described, caution being taken to precise the strength of the association between each side effect and the related drug by using the classification of World Health Organisation (WHO) (certain, probable, possible or unlikely).

[Rosary-like abnormality of retinal veins:report of a case]. / L'anomalie veineuse rétinienne en chapelet: à propos d'un cas.

Inherited retinal venous beading is a rare autosomal dominant disorder with variable expressivity. It is characterized by irregular, segmented beading of the retinal veins. Some patients have arteriolar tortuosity. The conjunctiva can be affected by saccular vascular changes. Episodes of acute retinal vascular decompensation are also described. Low to normal leucocyte and neutrophil counts may be an extraocular associated condition. We describe the isolated case of a woman presenting retinal venous beading and conjunctival vascular aneurysms. She has no systemic anomaly and her family members examined are unaffected.

[Important bilateral corneal astigmatism in a case of ocular ochronosis]. / Astigmatisme cornéen important bilatéral en cas d'ochronose oculaire.

Ochronosis or alkaptonuria is a rare, autosomal recessive metabolic disease where the enzyme homogentisic acid 1,2-dioxygenase is missing. This enzyme is necessary in the oxidation of phenylalanine and tyrosine. As a result of this defect homogentisic acid, which is normally produced during the metabolism of the two amino-acids, cannot be further metabolized and therefore accumulates in the serum. It is massively excreted in the urine and as it is oxidized, the urine turns dark, a feature termed alkaptonuria. Tissue pigmentation called ochronosis is due to the presence and the chemical binding in the connective tissue of oxidized and polymerised products of homogentisic acid. The most important complications of alkaptonuric ochronosis as arthropathy are related to deposition of ochronotic pigment in the affected organs. In ocular ochronosis, the pigment is found in the sclera, conjunctiva, and limbic cornea. Vision is usually not impaired. We report the case of a man aged 73 years, with ochronosis, who developped a marked, late-onset bilateral astigmatism, related to this sclero-limbic ochronotic pigment. The clinical evolution, the result of histological examination and the physiopathology of this astigmatism are discussed.

[Acute pancreatitis, papillary coloboma and serous macular detachment]. / Pancreátite aigue, colobome papillaire et décollement maculaire séreux.

A serous macular detachment in one eye with spontaneous flattening is seen twice during acute pancreatitis in a man aged thirty-four years who has a pancreatic malformation and an optic disc coloboma of this eye. Fluorescein angiography discloses the classic sequence of an optic disc pit complicated by maculopathy. Vascular leakage attributed to acute pancreatitis is also seen in the macula. Every time, both retinal detachment and vascular leakage have disappeared in few days. The mechanism responsible for the development of the macular detachment in this case is discussed.

[Fetal alcohol syndrome and bilateral uniform posterior haze of the cornea]. / Syndrome d'alcoolisme foetal et voile cornéen postérieur uniforme bilateral.

A boy aged 12 prematurely born presents several signs of fetal alcohol syndrome (FAS): mild mental retardation, staturoponderal delay, microcephaly, thin philtrum and vermillion of the upper lip. The ophthalmological aspects are: telecanthus, retinal vascular tortuosity, hypoplastic optic discs, hypermetropia, and an uniform, diffuse posterior haze on both corneas. This haze, which is not described till now as part of the syndrome, is not present in the other members of his family. Radiologic and biologic investigations (namely the profile of the urinary and seric amino acids, the urinary organic acids, and the research for mucopolysaccharides) are normal. Karyotype is normal as well as the research for fragile X which is negative.

[Superior oblique myokymia secondary to neurovascular compression]. / Myokymies du grand oblique secondaires à une compression neuro-vasculaire.

In a patient with superior oblique myokymia, a contact is visualised between the right trochlear nerve and a vascular structure by high resolution thin slices magnetic resonance images coupled to angio-MR. A similar contact is not visualised on the left side. This suggests that the neuro-vascular contact is the cause of this superior oblique myokymia and offers the possibility of neuro-surgical decompression if necessary.

[Internuclear bilateral pseudo-ophthalmoplegia and dermatomyositis]. / Pseudo-ophthalmoplégie internucléaire bilatérale et dermatomyosite.

A 60 year-old woman complaining of diplopia presents an ocular motility disturbance mimicking internuclear ophthalmoplegia. Idiopathic dermatomyositis is diagnosed by the help of clinical, biological, electrophysiological and histological data. The outcome is favorable under corticotherapy. Ocular muscle involvement is rare in dermatomyositis. An overlap syndrome with another auto-immune disorder like myasthenia should be excluded in this kind of manifestation.

[Peripheral ulcerative keratitis and a form of limited wegener's granulomatosis]. / Kératite périphérique ulcérative et forme limitée de la granulomatose de Wegener.

A man aged 68 years presents superior limbal infiltrates at his left eye two weeks before a marginal ulcer which quickly perforates. He has no systemic complaint. Clinical, biological, radiologic and histological evaluations disclose superior airways and lungs implications, an inflammatory syndrome, high ANCA (antineutrophiles cytoplamic antibodies) titer and vasculitis. There is no sign of renal involvement. A limited form of Wegener's granulomatosis is diagnosed. The outcome is favorable with a partial penetrating keratoplasty and systemic corticosteroid therapy in association with immunosuppressive drugs. This so called limited form of Wegener's granulomatosis is sight threatening when eye is the initial presentation. The early diagnostic and treatment will be performed by the help of ANCA in cases with subclinical systemic manifestations.

[Correlation between corneal hysteresis, corneal resistance factor, and ocular pulse amplitude in healthy subjects]. / Corrélation entre hystérèse cornéenne, facteur de résistance cornéen et amplitude de pulsation oculaire chez les sujets sains.

PURPOSE: The Ocular Response Analyzer (ORA) measures corneal biomechanical properties: corneal hysteresis (CH) and the corneal resistance factor (CRF). The Pascal Dynamic Contour Tonometer (PDCT) measures the ocular pulse amplitude (OPA), which represents the systolic-diastolic variation in intraocular pressure (IOP). Both ORA and OPA values are lower in glaucoma patients than in normal patients. Our purpose was to assess whether there is a correlation between CH, CRF, and OPA values in healthy subjects. DESIGN AND PARTICIPANTS: Prospective observational study including 81 eyes of 41 healthy adult volunteers. Patients with ocular eye disease, previous refractive or intraocular surgery, contact lenses, or topical or general medications were excluded. METHODS: Patients underwent four ORA, three OPA, and two Goldmann Applanation Tonometry (GAT) measurements. For each device, the mean of all measurements were considered for this study. The statistical analysis by Spearman rank correlations was performed for right (RE), left (LE), and both eyes. The correlation between the two eyes of each subject was taken into account and canonical correlations were calculated using the SAS statistical software to improve the power of the analysis. RESULTS: The mean age was 43.6 +/- 14.6 years. The mean central corneal thickness was 545 +/- 32 microm for RE, 553 +/- 34 microm for LE, and 550 +/- 32 microm for both eyes. The mean IOPGAT values for RE, LE, and both eyes were, respectively 14.3 +/- 2.9 mmHg, 14.0 +/- 2.9 mmHg, and 14.2 +/- 2.9 mmHg. Spearman correlations were not statistically significant for separated RE and LE analysis. For both eyes, these correlations were rS=0.210, p=0.193 for OPA/CH and rS=0.388, p=0.013 for OPA/CRF. The Spearman correlation was statistically significant for OPA/CRF. This result was confirmed by canonical correlations (p=0.002) and in addition, CH was statistically correlated to OPA in the latter analysis (p=0.010). CONCLUSION: A statistically significant correlation was found between corneal biomechanical property values as measured by ORA and ocular pulse amplitude values as measured by PDCT in healthy subjects.