Trefoil factor family 1, MUC5AC and human leucocyte antigen-DR expression by conjunctival cells in patients with glaucoma treated with chronic drugs: could these markers predict the success of glaucoma surgery?

AIMS: To evaluate conjunctival expression of trefoil factor family (TFF)1, MUC5AC and human leucocyte antigen (HLA)-DR in patients with glaucoma treated with topical drugs, and to determine whether these parameters can predict the outcome of glaucoma surgery. METHODS: 77 conjunctival impression cytology specimens were collected from 77 patients with glaucoma (66 receiving drops with preservative and 11 treated with preservative-free drops) and 43 controls. TFF1, MUC5AC and HLA-DR expression was analysed using flow cytometry. Trabeculectomy was performed in 56 patients; success was defined as an intraocular pressure (IOP) < or =15 mm Hg without any IOP-lowering drug at 6 months. RESULTS: The expression of TFF1, MUC5AC and HLA-DR was significantly higher in patients than in controls (p = 0.01, 0.05 and 0.004, respectively). A higher expression of MUC5AC was found in patients treated with preserved drops than in those receiving unpreserved drops (p = 0.04). A higher MUC5AC expression and a lower HLA-DR expression was observed in successful glaucoma surgeries than in failures. CONCLUSIONS: TFF1 and MUC5AC secretions are probably a response to mild ocular surface changes caused by long-term use of topical treatment. Their increased expression could be a predicting factor of further successful glaucoma surgery.

[Management of induced diplopia after orbital decompression: study of 87 interventions in 51 patients]. / Prise en charge des diplopies induites dans les décompressions orbitaires : étude de 87 interventions chez 51 patients.

OBJECTIVE: To evaluate early strabismus treatment in patients suffering from diplopia after orbital decompression for dysthyroid orbitopathy. PATIENTS AND METHODS: We conducted a chart review of 51 patients (87 orbits) who underwent orbital decompression from July 1998 to June 2007. Ocular deviations, incidence of diplopia according to the type of decompression performed and the type and results of strabismus surgery were evaluated. RESULTS: Diplopia was induced by decompression in 34.2% of patients, with no statistically significant difference with respect to the type of decompression performed. Forty-nine percent of patients had postoperative diplopia. Strabismus surgery was performed on average 10.9weeks after decompression. Diplopia persisted in two patients (8%). CONCLUSION: Early strabismus surgery and the intraoperative relaxed muscle positioning technique appear to provide favorable results. It allows for a more rapid rehabilitation. Better adapted choice of decompression technique may improve final outcomes.

[Activity-based financing: is ambulatory care profitable for the institution]. / T2A et chirurgie orbitopalpébrale : l'ambulatoire est-il vraiment rentable pour l'établissement ?

INTRODUCTION: The aim of this study was to evaluate the impact of the 11th version of the National Health System's Activity-Based Financing on the income of a University Hospital department for palpebral, lacrimal, and orbital surgeries. PATIENTS AND METHODS: The number of such surgeries in 2008 was based on the Medicalization Program of the Information System. Using the 11th version of the Activity-Based Financing for Diagnosis-Related Groups, we compared the income in both inpatient and outpatient settings. RESULTS: Two hundred and forty-eight patients undergoing palpebral, lacrimal, or orbital surgery between January and December 2008 were included, with 87% treated on an outpatient basis. The lower reimbursement for outpatient surgery resulted in a loss of 184,500 euros (79%) for our department compared to the inpatient procedure. DISCUSSION: With rigorous organization, ambulatory surgery is feasible for palpebral, lacrimal, and orbital surgery. Nonetheless, with department incomes related to activity, ambulatory care seems financially disadvantageous. Many departments are trying to develop an ambulatory structure, but the need to balance their budget requires improved coherence.

Branched-chain fatty acids, increased in tears of blepharitis patients, are not toxic for conjunctival cells.

AIM: The composition of the meibum of blepharitis patients is characterised by increased levels of branched-chain fatty acids (BCFAs) that return to normal values in patients treated with cyclins and lid hygiene. The aim of this study was to determine if BCFAs had toxic effects on conjunctival cells related to the disease. METHODS: Chang and IOBA-NHC conjunctival human cells were treated with BCFAs (isoC16 and isoC20) or palmitic acid as a control for 4 h or 24 h at 50 microM or 100 microM. Morphological and functional changes were investigated by measuring mitochondrial dehydrogenase activity, cell permeability, mitochondrial depolarisation, chromatin condensation, IL-1beta and reactive oxygen species production. RESULTS: None of the fatty acids modified the parameters of cytotoxicity in conjunctival cells in Chang or IOBA-NHC cell lines. Only the mitochondrial dehydrogenase activity was significantly decreased in relation to the isoC20 concentration increase. CONCLUSIONS: The increase in BCFAs in the tears of blepharitis patients does not consistently participate in the conjunctival cell changes throughout the course of the disease. Instead, it is likely an adaptive response of the ocular surface to the lack of tears, possibly increasing meibum fluidity, thus enhancing lacrimal film stability.

Differences in meibomian fatty acid composition in patients with meibomian gland dysfunction and aqueous-deficient dry eye.

AIMS: To evaluate the differences in meibomian fatty acid composition in healthy subjects and in patients suffering from meibomian gland dysfunction or aqueous-deficient dry eye. METHODS: We collected meibomian oil using a sterile Schirmer paper in healthy individuals (n = 20), dry eye patients (aqueous-deficient) (n = 32) and meibomian gland dysfunction (MGD) patients (n = 25) after gentle massage of the lid margin. Meibomian fatty acids were directly transmethylated and analysed using gas chromatography (GC) and GC mass spectrometry. RESULTS: Meibomian fatty acids were similar in healthy individuals and in dry eye patients but were different in MGD patients, who showed significantly higher levels of branched-chain fatty acids (29.8% vs 20.2%) (p<0.0001) and lower levels of saturated fatty acids (9.3 vs 24.6%) (p<0.0001), in particular lower levels of palmitic (C16) and stearic (C18) acids. CONCLUSION: The increase in branched-chain fatty acids may reflect greater quantities of wax and cholesterol esters and triglycerides in meibomian gland excreta. Since wax and cholesterol esters are the main lipids of meibum, these differences may have physical consequences for tear-film lipid-layer fluidity and stability. Meibomian fatty acid composition and particularly the increase in branched chains could be a marker for meibomian gland dysfunction.

Changes in meibomian fatty acids and clinical signs in patients with meibomian gland dysfunction after minocycline treatment.

AIMS: To assess the changes in ocular surface abnormalities and meibomian fatty acid composition in patients suffering from meibomian gland dysfunction (MGD) after treatment with oral minocycline associated with lid hygiene versus lid hygiene only. METHODS: We evaluated the break-up time, corneal staining and quality of meibomian excreta, and collected meibomian oil in 20 individuals suffering from MGD before and after 8 weeks of minocycline associated with lid hygiene (n = 10) or lid hygiene only (n = 10). Meibomian fatty acids were directly transmethylated and analysed by gas chromatography (GC) and GC mass spectrometry. RESULTS: The meibomian fatty acid composition was slightly modified after 8 weeks in both groups. The decrease in a branched-chain fatty acid (isoC20) was greater after minocycline treatment than after lid hygiene only (-65% and -25%, respectively; p<0.05). Other fatty acids were unchanged. A significant improvement in the BUT was observed after minocycline treatment (p = 0.03). CONCLUSION: This study showed better tear film stability after minocycline treatment and a biological effect on meibomian fatty acid composition in MGD patients. Minocycline was more effective than lid hygiene alone. Both interventions partly corrected fatty acid composition abnormalities. Among the fatty acids, isoC20 could be a biological marker of MGD.

[Screening diabetic retinopathy in Burgundy with an itinerant nonmydriatic camera]. / Dépistage de la rétinopathie diabétique en Bourgogne par un rétinographe non mydriatique itinérant.

INTRODUCTION: The aim of this study was to assess the suitability of screening diabetic retinopathy (DR) with an itinerant nonmydriatic camera. METHODS: This program required collaboration between ophthalmologists and general practitioners. Three professional organizations gave their support: L'union Professionnelle des Médecins Libéraux de Bourgogne (UPMLB), le Fonds d'Aide à la Qualité des Soins de Ville (FAQSV), et la Fédération des Associations des Diabétiques de Bourgogne (FADB). The screening programm took place from November 2004 to June 2005 throughout the Burgundy region. General practitioners, health professionals (pharmacists, nurses), local media, and health insurance offices informed patients of the DR screening. An orthoptist took photographs with a nonmydriatic digital camera. Each patient had four fundus photographs without pupillary dilatation. Photographs were analyzed in the Department of Ophthalmology of Dijon's General Hospital. RESULTS: In this study, 676 diabetic patients were screened. Among these patients, 58 had DR, exclusively nonproliferative retinopathies. Nine percent of the photographs were ungradable. The mean age of patients with DR was 65 years. The mean onset of diabetes was 18 years before the study. Insulin therapy was followed by 27 patients (46.6%). Hemoglobin A1c was known in 26 patients (44.8%), with a mean value of 8.14%. Nearly 60% of patients with DR did not have their recommended annual consultation. After screening, 84% of patients consulted an ophthalmologist. CONCLUSION: Screening DR with an itinerant nonmydriatic camera can improve ophthalmologic follow-up of diabetics in rural areas. This screening program has continued in 2006 with an adapted vehicle.