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Goldschmidt P.,Center Hospitalier National dOphtalmologie des Quinze Vingts | Einterz E.,Hopital de District de Kolofata
Tropical Medicine and Health | Year: 2014

Background: Health authorities are working toward the global elimination of trachoma by the year 2020 with actions focused on the World Health Organization SAFE strategy (surgery of trichiasis, antibiotics, face washing and environmental changes) with emphasis on hygienist approaches for education. Objectives: The present survey was performed to assess the sustainability of the SAFE strategy 3 years after trachoma was eliminated from 6 villages. Methods: In February 2013 a rapid trachoma assessment was conducted in 6 villages of Kolofata's district, Extreme north Region, Cameroon, where trachoma was eliminated in 2010. A total of 300 children (1-10 years) from 6 villages were examined by trained staff. Results: The prevalence of active trachoma (children aged > 1 and < 10 years) in 2013 was 15% and in at least 25% was observed absence of face washing and flies in their eyes and nose. Income level, quality of roads, hygiene, and illiteracy were similar in all the villages; they did not change between 2010 and 2013 and could not be analyzed as independent risk factors. Discussion: The heterogeneity of methods described for clinical trials makes it inappropriate to conduct meta-analysis for the present and for other SAFE-related trials. The results obtained after implementation the SAFE strategy (recurrence) reveal that the causes (infectious agents and dirtiness) and effects (illness) were not connected by illiterate people living under conditions of extreme poverty. So far, antibiotics, surgery and hygiene education are insufficient for the sustainability of trachoma elimination and highlight that hypothetic-deductive processes seem not operational after implementing the awareness campaigns. Trachoma recurrence detected in 2013 in sedentary populations of Kolofata receiving efficacious treatments against Chlamydia sp. suggest that the elimination goals will be delayed if strategies are limited to medical actions. Restricting efforts to repeated pharmacological and surgical interventions for people infected with susceptible bacteria could be understood as the hidden side of a passive attitude toward basic education actions. © 2014 by The Japanese Society of Tropical Medicine. Source


Pierru A.,Center Hospitalier National dOphtalmologie des Quinze Vingts | Pierru A.,Saint Roch University Hospital | Carles M.,Saint Roch University Hospital | Gastaud P.,Saint Roch University Hospital | Baillif S.,Saint Roch University Hospital
Investigative Ophthalmology and Visual Science | Year: 2014

Purpose. To compare subfoveal choroidal thickness (SFCT) before and after uneventful cataract surgery using enhanced depth imaging optical coherence tomography (EDI-OCT). Methods. A prospective study was conducted on 115 eyes of 95 patients who had phacoemulsification. Measurements of SFCT were performed preoperatively, 1 day (D1), 7 days (D7), 1 month (M1), and 3 months (M3) after surgery using the EDI-OCT technique. Central retinal thickness (CRT) was measured before surgery and at M1 and M3. Results. The 95 patients had a mean age of 76 ± 8.3 years. The mean SFCT at baseline was 224 ± 75 μm. It showed a negative correlation with age and axial length (P = 0.03). The SFCT significantly increased after surgery with a mean value of 232 ± 76 μm at D1 (P < 0.001), 237 ± 78 μm at M1 (P < 0.001), and 232 ± 76 μm at M3 (P < 0.001). The mean CRT increased from 234 ± 48 μm at baseline to 248 ± 48 μm at M1 (P = 0.005), and 252 ± 81 μm at M3 (P = 0.001). Three (2.6%) patients developed a pseudophakic cystoid macular edema (PCME). The greatest progression of SFCT after phacoemulsification was observed for these patients. It preceded the occurrence of pseudophakic cystoid macular edema (PCME) by 1 month. Conclusions. Mean SFCT increased after cataract surgery. The changes in baseline SFCT were greater in PCME patients and preceded the increase in CRT. © The Association for Research in Vision and Ophthalmology, Inc. Source


Zmuda M.,University Paris Est Creteil | Tiev K.P.,Center Hospitalier University Saint Antoine | Knoeri J.,Center Hospitalier National dOphtalmologie des Quinze Vingts | Heron E.,University Paris Est Creteil
Ocular Immunology and Inflammation | Year: 2013

Purpose: To report an experience with infliximab in severe corticosteroid-resistant Vogt-Koyanagi-Harada (VKH) disease. Design: Interventional case series. Methods: The medical records of 2 adult patients were reviewed. Results: Both patients had a visual acuity reduced to hand motion perception bilaterally after 1 month of high-dose corticosteroid therapy, due to multiple exudative retinal detachment involving the fovea. Visual acuity and OCT findings improved immediately after the first infliximab infusion, retinal detachments fully resolved after 1 month and visual acuity returned to normal within 6 months. Despite a negative pretreatment screening, one patient developed multivisceral tuberculosis, which led to infliximab discontinuation after the 7th infusion and was cured by a 9-month ambulatory antibiotic regimen. The other patient received 11 well-tolerated infliximab infusions. Respectively, 9 and 4 months after infliximab discontinuation both patients had normal vision and OCT findings. Conclusion: Infliximab showed tremendous therapeutic efficacy in sight-threatening corticosteroid-resistant VKH disease. © Informa Healthcare USA, Inc. Source


De Juan Jr. E.,University of California at San Francisco | Spencer R.,Retina Foundation of the Southwest | Barale P.-O.,Center Hospitalier National dOphtalmologie des Quinze Vingts | Da Cruz L.,Biomedical Research Center for Ophthalmology | Neysmith J.,Second Sight
Graefe's Archive for Clinical and Experimental Ophthalmology | Year: 2013

Background: Retinal tacks, first developed for the treatment of complex retinal detachments, have more recently been used for the fixation of epiretinal electrode arrays as part of implanted visual prostheses. Here, we report on the clinical experience of extracting four such tacks after chronic implantation. The ability to safely extract retinal tacks ensures that epiretinal devices can be repositioned or removed if necessary. Methods: Custom-built, titanium alloy retinal tacks were mechanically removed from the posterior coats after prolonged implantation (up to 19 months). The resulting wound was characterized by clinical evaluation, fundus photography, and fluorescein angiography while being monitored for stability over time. The wounds were also compared to earlier published reports of the healing response around retinal tacks in human subjects. Results: Tack extraction was accomplished successfully, without complication, in all four subjects. The wound site was readily identified by pale scar tissue. No change in the wound size or appearance was noted over many months of post-operative observation (up to 22 months after explant). No adverse effects on overall ocular health were detected. Conclusion: Extraction of retinal tacks from subjects implanted with epiretinal prostheses can be performed without significant complication. The long-term healing response appears to be stable and localized in eyes afflicted with retinitis pigmentosa or choroideremia. There was also minimal, if any, impact on the local circulatory system. These cases suggest that the use of retinal tacks for anchoring epiretinal visual prostheses does not preclude safe repositioning or removal of the device more than a year after implant. © 2013 Springer-Verlag Berlin Heidelberg. Source


Laroche L.,Center Hospitalier National dOphtalmologie des Quinze Vingts
Revue du Praticien | Year: 2013

Cataract surgery improves vision by restoring eye transparency and also by correcting previous refractive defects. Surgery has only to be done when the patient's quality of life is significantly impaired by vision troubles. Among patients with cognitive and behaviour troubles (i.e Alzheimer disease), surgery may improve cognitive scores, and autonomy. Multifocal intraocular lenses are sometimes indicated for correcting presbyopia. However, impairment of contrast sensitivity is constant, among adverse effects causing sometimes dissatisfaction. Therefore "monovision", with monofocal intraocular lenses may be proposed, in order to manage the loss of accommodation constant after cataract surgey. Patient's satisfaction level is high when the dominant eye is dedicated to far vision, and the other eye to near vision. Combining femtosecond laser technology and cataract surgery may in the future improve reproductibility and surgical outcomes, but is not currently responsible for obvious therapeutic benefits. Source

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