Jean-Philippe Nordmann

A double-masked randomized comparison of the efficacy and safety of unoprostone with timolol and betaxolol in patients with primary open-angle glaucoma including pseudoexfoliation glaucoma or ocular hypertension. 6 month data.

PURPOSE A long-term comparison of the ocular hypotensive efficacy and safety of unoprostone isopropyl 0.15% twice daily with that of timolol maleate 0.5% twice daily and betaxolol HCl 0.5% twice daily. DESIGN This was a randomized, multicenter, double-masked, active-controlled 24-month clinical trial involving 27 centers in Europe and Israel. METHODS The study population was composed of patients with primary open-angle glaucoma (including pseudoexfoliation) or ocular hypertension. After washout of antiglaucoma medications, intraocular pressure (IOP) was measured at 0, + 2, + 8, and + 12 hours. Patients were randomized in a 2:1:1 ratio to unoprostone, timolol, or betaxolol. Patients returned for examinations at 2 and 6 weeks and 3 and 6 months. RESULTS 556 patients were randomized. Each drug produced a clinically and statistically (P <.001) significant reduction from baseline in 12-hour diurnal IOP at month 6 (- 4.3 mm Hg, unoprostone; - 5.8 mm Hg, timolol; - 4.9 mm Hg, betaxolol). Differences in adjusted treatment means between unoprostone and timolol and unoprostone and betaxolol were 1.57 mm Hg (95% CI: 1.00, 2.13) and 0.53 mm Hg (95% CI: - 0.03, 1.09), respectively. Unoprostone was clinically equivalent to betaxolol but did not have as great an IOP-lowering effect as timolol. Discontinued for inadequate control of IOP were 7%, 1%, and 4% of the patients for unoprostone, timolol, and betaxolol, respectively. There were no changes of note in visual acuity, pupil size, cup-to-disk ratio, visual fields, or iris color. Changes in heart rate and blood pressure were small, with no clinically significant differences between groups. CONCLUSIONS Unoprostone provided a clinically significant IOP-lowering effect equivalent to betaxolol but not to timolol. The side effect profile of unoprostone appears to be comparable to other established IOP-lowering agents.

Measurement of health-related quality of life with glaucoma: validation of the Glau-QoL© 36-item questionnaire

Purpose:  To validate a glaucoma‐specific health‐related quality of life (HRQoL) questionnaire: the Glau‐QoL©.

Treatment of glaucoma in clinical practice: four-year results from a patient registry in France.

PurposeTo investigate long-term resource consumption and clinical outcome of patients with early primary open-angle glaucoma or ocular hypertension treated with prostaglandins in clinical practice in France. MethodsThirty-four geographically spread specialized hospitals and private practices enrolled consecutive patients receiving, for the first time, a prostaglandin, alone or in combination. The study was based on routine practice and no consultations, examinations, or treatments were mandated by the protocol. Treating physicians recorded each consultation, including all examinations performed, referrals, admissions, and prescriptions. Descriptive analysis of resource consumption and development of intraocular pressure (IOP) and visual fields was performed, for all patients who completed the 4-year follow-up. ResultsThe study enrolled 602 patients and 78% completed 4-year follow-up. Mean age was 65 years and mean time since diagnosis was 4 years. Mean IOP was reduced from a baseline of 21.2 mm Hg to 16.5 mm Hg during the first year and remained stable throughout the study. Mean visual fields at baseline were −4.2 mean deviation and stable during the follow-up. Total mean health care costs per patient were &U20AC;1947, of which medication represented 50%. Over half of the patients (52%) remained on their initial medication during the 4 years. Drug changes were mostly because of inadequate IOP control and the number of treatment switches was significantly related to costs. ConclusionsThis is the first prospective study of treatment with prostaglandins in clinical practice. The results indicate that many patients with early glaucoma managed primarily with prostaglandins will show very little progression over 4 years. Compared with the mid-90s, costs have not increased despite the higher acquisition cost of prostaglandins, as surgical interventions and medical consultations have decreased.

Evaluation of the Tono-Pen 2 and the X-PertTM Noncontact Tonometers in Cataract Surgery

The Oculab Tono-Pen and the X-Pert noncontact tonometers (NCTs) were compared to the Goldmann applanation tonometer in a consecutive series of 45 patients before and after cataract surgery. In the preoperative period, the mean value of the paired difference at intraocular pressure (IOP) measurements was -1.30 +/- 2.11 mm Hg (mean +/- SD) for the X-Pert NCT (X-Pert NCT minus Goldmann) and -0.19 +/- 2.56 mm Hg for the Tono-Pen 2 (Tono-Pen 2 minus Goldmann). In the postoperative period, this mean difference was 0.26 +/- 2.45 mm Hg for the X-Pert NCT and 0.87 +/- 2.83 mm Hg for the Tono-Pen 2. We found 87 and 67% of the X-Pert NCT and the Tono-Pen 2 readings to be within +/- 2 mm Hg of the Goldmann readings, respectively. In both preoperative and postoperative eyes, correlation coefficients between the readings of the three instruments were high (ranging from 0.84 to 0.96). Differences between the three tonometers were not correlated with corneal thickness of corneal curvature postoperatively. Both Tono-Pen 2 and X-Pert NCT could thus be considered accurate instruments for IOP screening after cataract surgery when compared to the Goldmann applanation tonometer.

Vasoactive intestinal peptide/peptide histidine isoleucine mRNA in the eye and suprachiasmatic nucleus of normal and monocularly enucleated rats

The localization of the messenger RNA (mRNA) encoding vasocative intestinal peptide/peptide histidine isoleucine (VIP/PHI) in the rat eye was studied by in situ hybridization histochemistry using a synthetic35“S-labeled oligodeoxyribonucleotide. Among the layers of the retina, specific labeling was found in the soma of some cells in the innermost lamina of the inner nuclear layer. Occasionally, labeled cells were also present in the ganglion cell layer. No specific labeling was detected in any ocular structures other than the retina, including the cornea, iris, ciliary body, choroid, choriocapillaris, optic nerve and sclera. We also examined VIP/PHI mRNA expression in the suprachiasmatic nucleus (SCN) of the hypothalamus, which is the pacemaker of circadian rhythms and synchronizes them with the environmental light-dark cycle. High labeling was found in the ventrolateral part of the nucleus, which is the site of most projections from the retina. Monocular enucleation of rats at birth resulted in an increase of VIP/PHI mRNA expression in SCN ipsilateral to the removed eye after postnatal day 60. The discrete pattern of hybridization for VIP/PHI mRNA indicates that these two peptides are synthetized in rat retina and SCN and suggests that they may play a key role in the photic entrainment to the SCN regulating various circadian rhythms.

Prise en charge de l’hypertonie oculaire et du glaucome chronique à angle ouvert par les ophtalmologistes français : rôle de la pression intra-oculaire cible

Introduction La baisse de la pression intra-oculaire (PIO) s’avere efficace pour stopper ou ralentir l’evolution du glaucome. Elle est essentielle pour limiter la conversion de l’hypertonie au glaucome. La valeur de la PIO a atteindre pour preserver le champ visuel et le nerf optique est appelee PIO cible. Cette etude se propose d’analyser les habitudes des ophtalmologistes francais pour en determiner sa valeur et de rendre compte de son importance dans le traitement et le suivi des patients. Materiels et methodes L’objectif principal de cette etude prospective nationale multicentrique etait d’analyser la prise en charge des sujets hypertones ou glaucomateux et d’evaluer la place de la PIO cible dans la strategie therapeutique. Resultats Neuf cent soixante-douze ophtalmologistes ont inclus 11 177 patients entre mai 2002 et mars 2004. Dans 68,7 % des cas, le praticien determinait une PIO a atteindre selon diverses methodes : objectifs de PIO cible a 15 mmHg, 17 mmHg ou pourcentage de baisse de PIO (recommandations de la Societe Europeenne du Glaucome, EGS). Cette PIO cible moyenne estimee variait de 14,3 a 17,3 mmHg. Discussion L’estimation de la PIO cible est un outil couramment utilise par la majorite des ophtalmologistes francais pour le suivi des patients hypertones et glaucomateux. Conclusion Cette etude est un instantane des habitudes des praticiens face a leurs patients glaucomateux, montrant que la determination de la PIO cible occupe une place de plus en plus importante dans la decision et le suivi therapeutique.

Immunohistochemical and Ultrastructural Study of the Cornea in Chandler's Syndrome

A comeal specimen obtained by surgery in a 55-year-old woman with Chandler’s syndrome was studied by light and transmission electron microscopy as well as by immunocytochemistry. The pathologic features were abnormalities of the endothelially derived cells lining the posterior comeal surface with a fibrous material consisting of collagen fibrils, filaments and banded material similar to that found in the anterior part of Descemet’s membrane observed between the endothelial cell layer and Descemet’s membrane. The multilayered endothelial cell layer in our case was found to be strongly positive for cytokeratins K7 and KL1 and vimentin and negative for factor-VIII-related antigen, neuron-specific enolase, nerve tissue S–100 protein, epithelial membrane antigen, CD 68, actin and desmin. This immunohistochemical reaction pattern argues in favor of an epithelial origin for cells lining the endothelial cell layer in Chandler’s syndrome.

Safety and efficacy of ranibizumab for pregnant women in idiopathic choroidal neovascularization.

member survey of the Japanese Society of Cataract and Refractive Surgery, acrylic IOLs were the most popular IOLs among the society members in Japan when most of the current cases underwent cataract surgery (62% of ophthalmologists preferred to use acrylic IOLs, while 24% used PMMA IOLs, 13% used silicone IOLs and 1% used hydrogel IOLs) (Sato et al. 2005). Although these do not exactly reflect the denominator, the rate of pseudophakic PEX among current cases seems much higher with PMMA IOLs than with the other IOL materials. In the literature, pseudophakic PEX developed in the presence of various materials including seven acrylic IOLs, three PMMA IOLs, two silicone IOLs, two collagen poly-HEMA/MMA copolymer IOLs and one unknown IOL material (Stewart & Jay 1995; Bahadur & Masket 2007; Park & Kee 2007; Roberts & Hawksworth 2009; Park & Ahn 2012; Kaliaperumal et al. 2013). With this study, we cannot calculate the incidence of pseudophakic PEX on each IOL materials, as we do not have the number of all cataract surgeries carried out in eight different surgical sites. Thus, it is important to note that our observation does not necessarily mean the incidence of pseudophakic PEX is higher with PMMA IOL than other IOL materials.

Parafoveal and optic disc vessel density in patients with obstructive sleep apnea syndrome: an optical coherence tomography angiography study

AimsTo compare optic disc perfusion, radial peripapillary capillaries (RPC) and macular vascular density, between normal subjects and subjects with obstructive sleep apnea syndrome (OSAS) using spectral-domain OCT angiography (OCTA).MethodsSixteen eyes of patients with mild OSAS, 17 eyes with moderate OSAS, 20 eyes with severe OSAS on polygraphy and 28 controls were evaluated with OCTA RT XR Avanti (AngioVue software, Optovue Inc., Fremont, CA). Optic nerve head (ONH), RPC and macular vessel density were measured. Clinical data, visual field parameters, and Spectral Domain OCT evaluation (retinal nerve fiber layer (RNFL) thickness and ganglion cell complex (GCC) thickness) were recorded for all patients.ResultsONH vascular flow (p = 0,396), RPC vascular density (automatized data “whole” p = 0,913, “peripapillary” p = 0,539, and segmented analysis with a topographic grid) and macular vascular density (foveal p = 0,484, parafoveal p = 0,491) were not significantly different between the four groups. FDT-Matrix™ and Humphrey 24/2 mean deviation were significantly lower in eyes with severe OSAS and were correlated to the apnea-hypopnea index. Retinal nerve fiber layer (RNFL) thickness, Cup/Disc ratio, rim area, and ganglion cell complex (GCC) were not significantly modified.ConclusionsOCTA did not detect reduced ONH, RPC, neither macular blood vessel density in eyes with OSAS. The precise mechanisms that link OSAS with optic nerve pathologies remain unclear: our study was not able to demonstrate a vascular impact by OCTA examination.

Use of Machine Learning on Contact Lens Sensor–Derived Parameters for the Diagnosis of Primary Open-angle Glaucoma

PURPOSE To test the hypothesis that contact lens sensor (CLS)-based 24-hour profiles of ocular volume changes contain information complementary to intraocular pressure (IOP) to discriminate between primary open-angle glaucoma (POAG) and healthy (H) eyes. DESIGN Development and evaluation of a diagnostic test with machine learning. METHODS Subjects: From 435 subjects (193 healthy and 242 POAG), 136 POAG and 136 age-matched healthy subjects were selected. Subjects with contraindications for CLS wear were excluded. PROCEDURE This is a pooled analysis of data from 24 prospective clinical studies and a registry. All subjects underwent 24-hour CLS recording on 1 eye. Statistical and physiological CLS parameters were derived from the signal recorded. CLS parameters frequently associated with the presence of POAG were identified using a random forest modeling approach. MAIN OUTCOME MEASURES Area under the receiver operating characteristic curve (ROC AUC) for feature sets including CLS parameters and Start IOP, as well as a feature set with CLS parameters and Start IOP combined. RESULTS The CLS parameters feature set discriminated POAG from H eyes with mean ROC AUCs of 0.611, confidence interval (CI) 0.493-0.722. Larger values of a given CLS parameter were in general associated with a diagnosis of POAG. The Start IOP feature set discriminated between POAG and H eyes with a mean ROC AUC of 0.681, CI 0.603-0.765. The combined feature set was the best indicator of POAG with an ROC AUC of 0.759, CI 0.654-0.855. This ROC AUC was statistically higher than for CLS parameters or Start IOP feature sets alone (both P < .0001). CONCLUSIONS CLS recordings contain information complementary to IOP that enable discrimination between H and POAG. The feature set combining CLS parameters and Start IOP provide a better indication of the presence of POAG than each of the feature sets separately. As such, the CLS may be a new biomarker for POAG.