Alergia

NOVEMBRO/DEZEMBRO 2010

Figus M, Fogagnolo P, Lazzeri S, Capizzi F, Romagnoli M, Canovetti A, Iester M, Ferreras A, Rossetti L, Nardi M.

Treatment of allergic conjunctivitis: results of a 1-month, single-masked randomized study.
Eur J Ophthalmol 2010; 20 (5): 811-818.

PURPOSE: To compare the effects of topical antiallergic eyedrops in relieving the signs and symptoms of patients with allergic conjunctival pathology.

METHODS: In this multicenter, single-masked, randomized study, 240 patients with signs and symptoms of allergic conjunctivitis were randomized to receive 1 of the following 8 treatments twice daily: cromolyn sodium/chlorpheniramine maleate, diclofenac, epinastine, fluorometholone, ketotifen, levocabastine, naphazoline/antazoline, and olopatadine. Clinical signs and symptoms were evaluated by a masked operator using a 10-point scale at the moment of enrollment (day 0) and at weeks 1, 2, and 4. The percentage of patients achieving at least a small (at least 50% reduction of the total scale score) or a good (at least 75%) improvement of signs and symptoms was calculated at each visit. Tolerability was also evaluated as the duration of discomfort after instillation.

RESULTS: All drugs gave some improvement in symptoms in more than 85% of cases. Epinastine and olopatadine obtained at least a good relief of symptoms in 37% and 33% of cases at week 1. At the end of the study, good improvement of symptoms was obtained in at least 70% of patients by epinastine, ketotifen, fluorometholone, and olopatadine, whereas a 75% improvement for signs was obtained only by fluorometholone and ketotifen. Naphazoline/antazoline induced higher discomfort compared to the other study treatments (p<0.0001).

CONCLUSIONS: The efficacy of epinastine, ketotifen, and olopatadine in the treatment of allergic conjunctivitis was comparable to fluorometholone. Naphazoline/antazoline had lower tolerability than the other study treatments.

Curtis LH, Hammill BG, Schulman KA, Cousins SW.

Risks of mortality, myocardial infarction, bleeding, and stroke associated with therapies for age-related macular degeneration.
Arch Ophthalmol 2010; 128 (10): 1273-1279.

OBJECTIVE: To examine associations between therapies for age-related macular degeneration and risks of all-cause mortality, incident myocardial infarction, bleeding, and incident stroke.

METHODS: We conducted a retrospective cohort study of 146,942 Medicare beneficiaries 65 years or older with a claim for age-related macular degeneration between January 1, 2005, and December 31, 2006. On the basis of claims for the initial treatment, we assigned beneficiaries to 1 of 4 groups. The active control group included patients who received photodynamic therapy. The other groups included patients who received intravitreous pegaptanib octasodium, bevacizumab, or ranibizumab. We censored data from patients when they received a therapy different from the initial therapy. The main outcome measures were associations between photodynamic, pegaptanib, bevacizumab, and ranibizumab therapies and the risks of all-cause mortality, incident myocardial infarction, bleeding, and incident stroke.

RESULTS: After adjustment for baseline characteristics and comorbid conditions, we found significant differences in the rates of mortality and myocardial infarction by treatment group. Specifically, the hazard of mortality was significantly lower with ranibizumab therapy than with photodynamic therapy (hazard ratio, 0.85; 99% confidence interval, 0.75-0.95) or pegaptanib use (0.84; 0.74-0.95), and the hazard of myocardial infarction was significantly lower with ranibizumab use than with photodynamic therapy (0.73; 0.58-0.92). There were no significant differences in the hazard of mortality or myocardial infarction between bevacizumab use and the other therapies. We found no statistically significant relationship between treatment group and bleeding events or stroke.

CONCLUSION: Bevacizumab and ranibizumab use was not associated with increased risks of mortality, myocardial infarction, bleeding, or stroke compared with photodynamic therapy or pegaptanib use.

JUNHO/JULHO/AGOSTO 2010

Sacchetti M, Lambiase A, Mantelli F, Deligianni V, Leonardi A, Bonini S.
Tailored approach to the treatment of vernal keratoconjunctivitis.
Ophthalmology 2010; 117 (7): 1294-1299.

PURPOSE: To develop a standardized clinical grading system for the management of patients with vernal keratoconjunctivitis (VKC) and to identify the risk factors associated with a worsened outcome of the disease, including decrease of visual acuity and ocular complications development.

DESIGN: Retrospective cohort study.

PARTICIPANTS: A total of 207 consecutive patients with VKC, referred to our Cornea and External Diseases Center from 1997 to 2007, were included in the study. A total of 110 of those patients were included in the follow-up study (range 1-10 years).

METHODS: Classifica-tion and regression tree (CART) analysis was performed to separate the patients into 5 subgroups by therapeutic approach. Regression tree and multivariate logistic regression analyses were performed during follow-up to identify predictors of worse visual outcome.

MAIN OUTCOME MEASURES: Age, gender, duration and course of disease, signs, symptoms, overall symptoms score, history of ato-py, markers of allergy, best-corrected visual acuity, and therapy were collected at baseline and during follow-up. The number of relapses and number of patients with decreased visual acuity were also eva-luated in the follow-up.

RESULTS: A decision tree for VKC treatment was developed by CART ana-lysis, and a new clinical grading system was proposed accordingly. Sixteen patients were classified as grade 0 (absence of symptoms and no therapy); 59 patients were classified as grade 1 (presence of symptoms without photophobia, occasional use of anti-allergic eye drop); 74 patients were classified as grade 2 (presence of symptoms including photophobia, daily anti-allergic treatment); 22 patients with superficial punctuate keratopathy (SPK) were classified as grade 3 (daily anti-allergic treatment associated with occasional topical steroid); and 36 patients were classified as grade 4 (diffuse SPK or corneal ulcer; pulsed high-dose topical steroid). A higher number of relapses and a higher baseline grade of VKC were the main predictor factors for worse visual outcome.

CONCLUSIONS: This gra-ding system allows for identifying the more severe forms of VKC that are at higher risk of recurrences, corneal ulceration, and worse final visual outcome.

FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

De Monchy Y.

Préserver la surface oculaire, un nouveau traitement de l’allergie en Algérie
Réflexions Ophtalmol 2010; 15 (136): 46-48.

Les effets toxiques des conservateurs : preuves expérimentales. Pauly A.
Les effets des conservateurs sur la surface oculaire : aspects cliniques. Labbé A.
Les conjonctivites allergiques de l’adulte (saisonnières perannuelles et atopiques. Doan S.
Les kératoconjonctivites vernales en Algérie : clinique et thérapeutique. Hartani D.
Les kératoconjonctivites vernales en Algérie : aspects cliniques particulier. Lazreg S.

Mortemousque B.

Allergie oculaire : quoi de neuf ?
Réalités Ophtalmol 2010; 172: 60-63.

Palmares J, Delgado L, Cidade M, Quadrado MJ, Filipe HP; Season Study Group.

Allergic conjunctivitis: a national cross-sectional study of clinical characteristics and quality of life.
Eur J Ophthalmol 2010; 20 (2): 257-264.

PURPOSE: Ocular allergy is one of the most common ocular problems in clinical practice and, al-though easily identified and frequently a mild to moderate condition, it has relevant direct and indirect costs. To characterize clinical and demographic aspects of allergic conjunctivitis in Portugal, using a structured questionnaire. As a secondary outcome, patient's initial therapeutic and health care options, self-perception of health, and work/school absenteeism were also evaluated.

METHODS: A cross-sectional study, in 16 ophthalmology departments of central or regional hospitals, in patients diagnosed with allergic conjunctivitis during the spring of 2006.

RESULTS: A total of 220 patients were enrolled (mean age of 31.4+/-18.5 years). A quarter of these patients had >5 episodes of ocular allergy in the past year, 59.3% all year-round episodes, and most presented associated comorbidities (allergic rhinitis 45.9%, asthma 15.5%). They had significant impairment of their overall quality of life during an acute episode (45.6% > or =6 in a 10-point severity scale). Only 19.4% had an appointment with an ophthalmologist as a first action and most (56.1%) started with self treatment measures. Only 37.2% had a previous allergy diagnostic evaluation.

CONCLUSIONS: In this cross-sectional study of allergic conjunctivitis patients seen in ophthalmology departments, we found a significant impairment of self-rated health status during an ocular allergy episode. Moreover, most patients had year-round episodes and started ocular allergy management with self treatment measures.

ABRIL/MAIO 2010

Figus M, Fogagnolo P, Lazzeri S, Capizzi F, Romagnoli M, Canovetti A, Iester M, Ferreras A, Rossetti L, Nardi M.

Treatment of allergic conjunctivitis: results of a 1-month, single-masked randomized study;
Eur J Ophthalmol 2010. Article in press.

PURPOSE: To compare the effects of topical antiallergic eyedrops in relieving the signs and symptoms of patients with allergic conjunctival pathology.

Bielory L, Bielory B

Ocular allergy: an allergist’s perspective
Advanced Ocular Care 2010; 1 (3): 50-53.

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