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JANEIRO 2011
Lecleire-Collet A, Massin P.
Nouveautés dans le traitement de l’OMD. Résultats des études internationales récentes.
Cahiers Ophtalmol 2010; 143: 37-39, 41-44.
Alors que la rétinopathie diabétique proliférante est la principale complication responsable de cécité au cours du diabète, l’œdème maculaire diabétique (OMD) est plus fréquent et constitue quant à lui la cause majeure de perte de vision modérée chez les patients diabétiques.
Parmi les premières études de phase II, puis de phase III, comparant les anti-VEGF (et les corticoïdes) au laser ou l’association de ces traitements dans l’OMD, un certain nombre sont aujourd’hui achevées et les premiers résultats disponibles. Quels sont les traitements les plus efficaces, avec quels effets secondaires ? Quelles fréquences de surveillance et de traitement semblent nécessaires ?
NOVEMBRO/DEZEMBRO 2010
Uematsu M, Kumagami T, Shimoda K, Kusano M, Teshima M, Sasaki H, Kitaoka T.
Influence of alkyl chain length of benzalkonium chloride on acute corneal epithelial toxicity.
Cornea 2010; 29 (11): 1296-1301.
PURPOSE: To evaluate acute corneal epithelial toxicity induced by benzalkonium chloride (BAC) homologs with different alkyl chain lengths using an in vivo electrophysiological method.
METHODS: BAC homologs with C12, C14, and C16 alkyl chain lengths were used at concentrations of 0.0025%, 0.005%, and 0.01%, respectively. Cytotoxicity of BAC homologs on the normal rabbit corneal epithelial cells was examined by using a WST-1 assay. Corneal transepithelial electrical resistance (TER) was measured in living Japanese white rabbits by 2 Ag/AgCl electrodes placed in the anterior aqueous chamber and on the cornea. TER changes were then evaluated after a 60-second exposure to these BAC homologs. Morphological changes in corneal epithelium after exposure to the BAC homologs were examined using scanning electron microscopy. The antimicrobial activity of BAC homologs against Escherichia coli was also assessed.
RESULTS: All BAC homologs caused cytotoxicity and corneal barrier dysfunction in a concentration-dependent manner. However, the degree of corneal toxicity differed among the BAC homologs. Based on cytotoxicity and TER measurement, C14-BAC caused the greatest corneal impairment followed in order of severity by mixed BAC/C16-BAC and C12-BAC. Scanning electron microscopy images indicated an intact corneal epithelium after exposure to 0.005% C12-BAC, whereas 0.005% C14-BAC damaged the epithelium. There were no remarkable differences noted in the antimicrobial activity among the BAC homologs.
CONCLUSIONS: Acute corneal epithelial toxicity induced by BAC homologs depends on the alkyl chain length. Thus, the use of C12-BAC instead of commercially available BAC is potentially safer for patients undergoing ophthalmological pharmacotherapy.
SETEMBRO/OUTUBRO 2010
Zarbin MA, Montemagno C, Leary JF, Ritch R.
Nanomedicine in ophthalmology: the new frontier.
Am J Ophthalmol 2010; 150 (2): 144-162.
PURPOSE: To review the fields of nanotechnology and nanomedicine as they relate to the development of treatments for vision-threatening disorders.
DESIGN: Perspective following literature review.
METHODS: Analysis of relevant publications in the peer-reviewed scientific literature.
RESULTS: Nanotechnology involves the creation and use of materials and devices at the size scale of intracellular structures and molecules and involves systems and constructs on the order of <100 nm. The aim of nanomedicine is the comprehensive monitoring, control, construction, repair, defense, and improvement of human biological systems at the molecular level, using engineered nanodevices and nanostructures, operating massively in parallel at the single cell level, ultimately to achieve medical benefit. The earliest impact of nanomedicine is likely to involve the areas of biopharmaceuticals (eg, drug delivery, drug discovery), implantable materials (eg, tissue regeneration scaffolds, bioresorbable materials), implantable devices (eg, intraocular pressure monitors, glaucoma drainage valves), and diagnostic tools (eg, genetic testing, imaging, intraocular pressure monitoring). Nanotechnology will bring about the development of regenerative medicine (ie, replacement and improvement of cells, tissues, and organs), ultrahigh-resolution in vivo imaging, microsensors and feedback devices, and artificial vision. "Regenerative nanomedicine," a new subfield of nanomedicine, uses nanoparticles containing gene transcription factors and other modulating molecules that allow for the reprogramming of cells in vivo.
CONCLUSIONS: Nanotechnology already has been applied to the measurement and treatment of different disease states in ophthalmology (including early- and late-stage disease), and many additional innovations will occur during the next century.
Parkkari M, Latvala T, Ropo A.
Handling test of eye drop dispenser--comparison of unit-dose pipettes with conventional eye drop bottles.
J Ocul Pharmacol Ther 2010; 26 (3): 273-6.
Abstract
PURPOSE: The aims of this study were to investigate how elderly people handle single-use eye drop dispensers (unit-dose pipettes) and to compare the performance with conventional eye drop bottles.
METHODS: In this open-label study, the handling of unit-dose pipettes and conventional eye drop bottles was compared in 41 elderly people who had little or no prior regular use of eye drop dispensers. The participants tested both types of dispenser once, and the following 7 variables were studied: ease/difficulty of opening the dispenser; influence of the size for handling of the dispenser; influence of the shape for handling of the dispenser; observation of the contents in the dispenser; the feeling of the dispenser in the hand; ease/difficulty of drop instillation on the eye from the dispenser; and overall performance of the eye drop dispenser. The dispensers contained isotonic saline, and a visual analog scale was used for assessment of each of the above variables.
RESULTS: The mean age of the participants was 73 years. A statistically significant difference in fa-vor of the unit-dose pipettes was found with respect to observation of the contents in the dispenser, ease of administration, and the overall performance. Women regarded the unit-dose pipettes generally better than the bottles, but such a difference was not seen in men.
CONCLUSIONS: The study participants managed the unit-dose pipettes at least as well as the conventional eye drop bottles. If anything, the unit-dose pipettes appeared to be easier to use.
JUNHO/JULHO/AGOSTO 2010
Sainz-Gómez C, Fernández-Robredo P, Salinas-Alamán A, Montañés JM, Escudero Berasategui JM, Guillén-Grima F, Ruiz-Moreno JM, García-Layana A.
Prevalence and causes of bilateral blindness and visual impairment among institutionalized eld-erly people in Pamplona, Spain.
Eur J Ophthalmol 2010; 20 (2): 442-450.
PURPOSE: To estimate the prevalence and causes of bilateral blindness and visual impairment in an urban institutionalized population aged 65 years and older. METHODS: A total of 392 nursing home residents completed a standardized eye examination, including measurement of visual acuity (VA), intraocular pressure, lens opacity grading, indirect ophthalmoscopy, and photography of the macular area. The major causes of vision loss identified for all participants were blindness and visual impair-ment. RESULTS: The average subject age was 82 years (65-97); women outnumbered men 263 to 129. The prevalence of bilateral blindness (VA > or =1.0 logarithm of the minimum angle of resolution [logMAR]) was 14.9% (43/288); the prevalence of visual impairment (VA > or =0.5 and 1.0 logMAR) was 31.9% (92/288). Blindness and visual impairment increased significantly with age (p<0.05), odds ratio (OR) 1.047 and 1.088, respectively. Cataract was the most common cause of bilateral blindness and visual impairment (27.9% and 44.6%, respectively) followed by pathologic myopia (23.3%) and age-related macular degeneration (AMD) (20.9%) for blindness, and by AMD (27.2%) and pathologic myopia (12%) for visual impairment. Fifty percent of subjects with visual loss had the potential for improved vision with medical or surgical intervention. CONCLUSIONS: Although the prevalences were high, these data are important since it is difficult for epidemiologic studies to include aged, insti-tutionalized individuals, although their numbers are increasing. Recognition of the predominant causes of visual loss dependent on age is fundamental for early diagnosis and treatment of ocular diseases. Many cases of low vision can be treated with appropriate ophthalmologic care.
Blephasteam, solution simple de thermothérapie.
Pratiques en ophtalmologie 2010; 4 (34): 140.
MARÇO 2010
Somner JE, Cavanagh DJ, Wong KK, Whitelaw M, Thomson T, Mansfield D.
The precautionary principle: what is the risk of reusing disposable drops in routine ophthalmology consultations and what are the costs of reducing this risk to zero?
Eye (Lond) 2010; 24 (2): 361-363.
BACKGROUND: Instilling eye drops is a ubiquitous procedure in eye clinics. This audit aimed to assess the risk of contamination of disposable droppers and to quantify the financial and waste impli-cations of reducing this risk to zero by using disposable droppers only once. METHODS: A total of 100 disposable Minims were used to place one drop in each eye of 70 patients. The dropper tip was then cultured for aerobic and anaerobic microbes. RESULTS: Coagulase-negative staphylococcus was cultured from five samples. The contamination rate per drop application was 2.5%. The risk of cross-contamination with coagulase-negative staphylococcus would be between 1 : 400 and 1 : 80 if the bot-tle was reused once or six times. Reducing this risk to zero costs between pound2.75 and pound4.6 million per annum and generates between 6.85 and 11.42 more tonnes of paper waste and between 12.69 and 21.15 more tonnes of plastic waste than a strategy that reuses the disposable dropper. CON-CLUSION: Reducing the risk of dropper contamination and subsequent cross infection has financial and environmental costs. As exposure to coagulase-negative staphylococcus is not necessarily associ-ated with infection, it would be useful to decide acceptable risk levels for a given cost to maximise both cost-effectiveness and patient safety.
Pijl BJ, Theelen T, Tilanus MA, Rentenaar R, Crama N.
Acute endophthalmitis after cataract surgery: 250 consecutive cases treated at a tertiary referral center in the Netherlands.
Am J Ophthalmol 2010; 149 (3): 482-487.e1-2.
PURPOSE: To evaluate the clinical characteristics, bacterial culture, and visual outcome of patients with acute endophthalmitis after cataract surgery. DESIGN: Retrospective consecutive interventional case series. METHODS: Clinical notes from patients treated for acute endophthalmitis after cataract surgery in a single center from 1996 to 2006 were reviewed. Patients with less than 1 month of follow-up and missing bacterial cultures were excluded. Vitreous biopsy or primary vitrectomy followed by intravitreal injection of vancomycin and ceftazidime (+/- prednisolone) was performed. Main outcome measures were bacterial culture and final visual acuity. RESULTS: Bacterial cultures (total 250 cases) showed bacterial growth in 166 cases (66.4%). From these 166 cultures, 89 (53.6%) revealed gram-positive coagulase-negative, 63 (38.0%) other gram-positive, 10 (6.0%) gram-negative, and 4 (2.4%) polymicrobial cultures. Vitreous biopsy with intravitreal antibiotics injection was performed in 225 (90.0%) of cases. Primary vitrectomy with intravitreal antibiotics was performed in 25 eyes (10.0%). Final visual acuity >/=0.5 was achieved in 129 (51.6%) of all cases, 54 (60.7%) of the 89 gram-positive coagulase-negative cultures, 20 (31.7%) of the 63 other gram-positive cultures, 5 (50.0%) of the 10 gram-negative cultures, and 9 (45.0%) of the 20 Staphylococcus aureus cultures. There was no additional effect for treatment by primary vitrectomy or intravitreal prednisolone. CONCLUSIONS: Treatment outcome after endophthalmitis is highly dependent on the causative organism. Treatment outcomes for gram-negative bacteria and S. aureus may be better than previously reported. Prompt treatment of endophthalmitis remains essential and the role of complete primary vitrectomy remains subject to debate. (c) 2010 Elsevier Inc. All rights reserved.
FEVEREIRO 2010
MacDonald ECA, Lockington D, Roberts F, Tetley L, Ramaesh K.
Unit-dose dispenser tips: a potential source of ocular injury
Br J Ophthalmol 2010; 94 (1): 136-137
Les Cahiers d’ophtalmologie n° 136 – janvier 2010
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Les Cahiers d’ophtalmologie n° 137 – février 2010
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Henrik Sjögren, 1899-1986
Murube J
The Ocular Surface 2010; 8 (1): 2-7.
