Catherine Creuzot Garcher

Expression of Inflammatory Membrane Markers by Conjunctival Cells in Chronically Treated Patients with Glaucoma

PURPOSE Recent histologic studies of conjunctival tissues in patients who have had long-term treatment for glaucoma have shown in situ an abnormal infiltration by inflammatory cells. In this study, conjunctival inflammatory antigens were investigated in impression cytology specimens from patients who have been and those who have not been treated for glaucoma. METHODS This study included 107 eyes from 55 patients with primary open-angle glaucoma. Of these, 48 had received prolonged topical treatments, all containing benzalkonium chloride as a preservative. Seven glaucomatous eyes could be examined before any treatment. In addition, the authors examined 11 patients (21 eyes) receiving anticataract eye drops preserved with chlorhexidine and 15 normal untreated subjects (30 eyes). In all patients, immunocytochemistry was performed in impression cytology specimens, using two monoclonal antibodies against HLA-DR antigens and receptor to IgE CD23. RESULTS None of the untreated eyes showed reactivity for either monoclonal antibody. In contrast, HLA-DR expression by conjunctival cells was found in 43 of 88 treated eyes (mean percentage of reactive cells, 70% +/- 28%) and positive staining for receptor to IgE in 26 of 68 eyes (52% +/- 28% of conjunctival cells). Results were not related to a specific treatment or combination of anti-glaucoma drugs. However, the proportion of positive specimens (3/14 for both antigens) in the group receiving chlorhexidine-containing eye drops was significantly lower than that found in the patients with glaucoma. CONCLUSION This study showed abnormal expression of inflammatory markers without clinical inflammation at the level of conjunctival cells in repetitive contact with various anti-glaucomatous treatments and their common preservative, benzalkonium chloride. Failure in filtering glaucoma surgery was found to be related to prolonged medical treatment; therefore, a topical sensitization to preservatives and/or anti-glaucoma drugs has been hypothesized. An immunocytologic test thus could be useful for qualitative and quantitative investigation of drug-induced conjunctival inflammation and predict high-risk patients.

CA 19-9 ELISA test: a new method for studying mucus changes in tears

AIMS This study investigated mucus changes in the tears in various eye conditions using impression cytology. The quantity of mucins was measured by enzyme linked immunosorbent assay (ELISA) using the tumour marker CA 19-9. This assay quantifies the sialylated Lewisa structure mainly associated with ocular mucins. METHODS Impression cytology was performed using a cellulose nitrate membrane, on 53 healthy patients, 50 glaucoma patients treated with β blockers, 24 patients suffering from dry eye syndrome, and 45 contact lens wearers. The tear film glycoproteins were eluted and CA 19-9 was measured. RESULTS CA 19-9 content expressed as kilo units (kU) per μg of tears was significantly decreased in dry eye syndrome (25.8 kU (SD 17.3)/μg) (p<0.05), glaucoma patients over 60 years (28.9 (19.5) kU/μg) (p<0.05), and contact lens wearers (28.4 kU (18)/μg) (p<0.05), when compared with healthy individuals (39.4 kU (22.2)/μg). CONCLUSION Impression cytology can be regarded as a valuable method for obtaining samples of glycoconjugates of mucin. The decrease of sialylated chains observed with this method confirms the hypothesis that some quantitative changes in the tear film may be encountered in ocular surface disorders.

Occurrence and risk factors for retinal detachment after pars plana vitrectomy in acute postcataract bacterial endophthalmitis

Background/aims To report the incidence, risk factors and prognosis of retinal detachment (RD) in patients who had vitrectomy for acute bacterial endophthalmitis after cataract surgery. Methods 123 patients with acute postcataract endophthalmitis, consecutively treated with pars plana vitrectomy (PPV) were included by the French Institutional Endophthalmitis Study group, in a prospective multicentre cohort study. Risk factors of RD were analysed using logistic regression. Results At the 6-month follow-up, the rate of post-PPV RD was 13% (n=16). The risk factors of post-PPV RD were diabetes (OR=4.7 (1.4–15.4), p=0.01) and visualisation of retinal vasculitis on the posterior pole (OR=3.8 (1.1–13.9), p=0.03) at the time of PPV. Postoperative RD occurred in 56% (n=9) of cases in the first month, in 31% (n=5) in the second month and in 6% (n=1) in the third month, with a mean delay of 47±71 days after PPV. The macula was detached in 12 cases (75%) and proliferative vitreoretinopathy grade C was present in seven cases. Final successful reattachment of the retina was obtained in 60% (n=9/15) of cases, with one (7/9) or two surgeries (2/9). Final visual acuity after surgical repair was ≥20/40 in 19% of cases, compared with 43% in patients without RD (p=0.05). Conclusions RD is a major and severe complication of PPV performed in patients with acute postcataract endophthalmitis. Retinal vasculitis is a major risk factor of RD after PPV. Anatomical and functional outcome remain poor.

Gentamicin, norfloxacin and lysozyme concentration in human tears: in vivo and in vitro study

Abstract Hens egg lysozyme (HEL) activity was measured in vitro with gentamicin and norfloxacin by a turbidimetric technique. Gentamicin at the concentration of 10‐3 M inhibited HEL activity by 39%, while 10‐3 M norfloxacin did not affect HEL activity. However, an in vivo study in healthy persons did not show any significant statistical difference in tear lysozyme activity when 0.3% gentamicin or 0.3% norfloxacin were topically applied.

Intravitreal corticosteroids as first-line adjunctive treatment in acute post cataract surgery endophthalmitis

Purpose To assess the effect of intravitreal corticosteroids as first-line adjunctive treatment in acute post cataract surgery endophthalmitis. Methods We conducted a multicenter prospective, randomized, single-masked study including patients with acute post cataract surgery endophthalmitis. All patients received the initial intravitreal antibiotics (vancomycine 1mg, ceftazidime 2mg) with intravitreal betamethasone (400 μg) in the group 1 but not in the group 2. At day 2, all patients had the same invitreal antibiotics with betamethasone (400 μg). A prompt or deferred vitrectomy could be associated with this treatment if baseline visual acuity was limited to light perception. The primary endpoint was the BCVA (logMAR) and the secondary endpoint was the impact on intraocular pressure Results We report the preliminary results on the first 54 patients;. 24 patients were included in the group 1 and 30 in the group 2. The BCVA was better in the group 1 at 8 days (1.44 ± 0.90 vs 1.90 ± 1.0 logMAR), at one month (0.50 ± 0.69 vs 1.24 ± 1.11 logMAR) and at 3 months (0.52 ± 0.87 vs 0.99 ± 1.13 logMAR). The confidence intervals were overlapping, except at one month, suggesting a statistical significance at this point. There was no difference in both groups considering the intraocular pressure at day 8: 14.13 mmHg (IC 95%: 10.29-17.97) in the group 1 and 12.52 mmHg (IC 95%: 10.49-14.55) in the group 2. Conclusion Intravitreal corticosteroids as a first line adjunctive treatment in acute post cataract surgery endophthalmitis seem to accelerate the recovery of visual acuity but do not seem to have an impact on the final functional outcome. These results need to be confirmed by the statistical analysis of the cohort of 100 cases.

164 Caractérisation clinique des endophtalmies aiguës post chirurgie de la cataracte à streptocoques ou staphylocoques

Introduction Les patients atteints d’endophtamie aigue post-operatoire se presentent avec un tableau clinique variable. Il serait interessant d’identifier quels sont les facteurs cliniques qui seraient associes a la presence de germes virulents. Le but de cette etude prospective multicentrique etait de differencier les infections a streptocoques de celles a staphylocoques sur la base des signes cliniques initiaux. Materiels et Methodes Dans le cadre de l’etude multicentrique du groupe FRIENDS (FRench Instutionnal ENdophthalmitis Study), les donnees demographiques, les antecedents medico-chirurgicaux et les donnees de l’examen clinique initial ont ete colligees de facon standardisee chez 100 patients atteints d’endophtalmie aigue ( Resultats 100 patients etaient inclus, d’âge moyen de 72 ans, et hospitalises avec un delai moyen de 8 ± 7.5 jours (2-31) apres la chirurgie de la cataracte. La chirurgie initiale etait compliquee de rupture capsulaire dans 19 % des cas. Les symptomes principaux etaient la diminution de la vision (95 %), souvent limitee a des perceptions lumineuses (32 %), et la douleur (75 %). Les principaux signes cliniques etaient l’hypopion (72 %), la membrane cyclitique (78 %) et l’absence de visualisation du fond d’œil (90 %). Les patients atteints d’endophtalmie a streptocoque (n = 19) se differenciaient des patients infectes par le staphylocoque (n = 47) par une plus grande frequence (p Discussion La plus grande virulence des streptocoques est bien correlee a des signes cliniques initiaux de gravite. Conclusion Les caracteristiques initiales des endophtalmies aigues a l’ere de la phacoemulsification ne different pas de celles decrites en 1995 lors de l’etude de l’EVS. Les infections a streptocoques, de pronostic defavorable, doivent etre suspectees chez les hommes diabetiques avec une acuite visuelle initiale limitee a des perceptions lumineuses. Ces patients doivent beneficier d’une vitrectomie posterieure dans les meilleurs delais.