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International audience; The purpose of this study is to assess in vivo whether diagnostic lumbar puncture (LP) is followed by optic nerve head (ONH) and parapapillary anatomic changes in normal human eyes.MATERIALS AND METHODS:Prospective, single-center, observational case series. ONH structures (prelaminar tissue surface, anterior surface of the lamina cribrosa, central retinal vessels) and parapapillary structures (internal limiting membrane, posterior surfaces of retinal nerve fiber layer and Bruch membrane/retinal pigment epithelium complex, Bruch membrane opening, posterior surface of the choroid) were quantitatively evaluated by means of swept-source optical coherence tomography (Triton Ver.10.05, Topcon, Tokyo, Japan) before and after LP (5, 60, and 360 min). Each of these structures was manually delineated for measurement before being superimposed to detect any displacement, using peripheral margins of parapapillary structures as a reference plane.RESULTS:A total of 16 eyes of 8 nonglaucomatous patients were evaluated. The CSF volume was median (IQR), 1.65 mL (1.16 to 2.00) and none of the ONH structures showed any anatomic changes at any time point after LP.CONCLUSIONS:According to the design of this study, diagnostic LP is a safe procedure regarding deep ONH structures in nonglaucomatous subjects.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.; Purpose: Low cerebrospinal fluid pressure (CSF-P) has been associated with the pathogenesis of glaucomatous optic neuropathy, in particular in patients with low-tension glaucoma, and glaucoma has been associated with optic nerve head (ONH) and lamina cribrosa (LC) positional changes. The aim of this study was to determine the effect of acute CSF-P reduction on ONH and anterior LC displacement using swept-source optical coherence tomography (SS-OCT) in healthy subjects. Methods: In this interventional study, 16 eyes of 8 in-patient adults benefiting from diagnostic lumbar puncture (LP) for non-ocular diseases were recruited prospectively. All ONH and LC imaging were performed using a commercially available SS-OCT device (6mm, 164 overlap) before, 5, 60 and 360 minutes after LP. The internal limiting membrane (ILM), posterior surface of the Bruch’s membrane/retinal pigment epithelium complex (BM/RPE), neural canal opening (NCO), retinal vessels (RV), outer limit of the choroid (ELC) and anterior LC surface (ALCS) were manually delineated by 3 separate observers and compared. Results: Four males and four females were recruited with a mean age, 50.4 ± 11.5 years and a mean body mass index, 22.7 ± 4.6 kg/m2). Mean volume of CSF collected was 1,63 ± 0,53 mL. At all times after LP, we did not observe any displacement of ILM, BM/RPE, NCO, RV, ELC or ALCS, even for two patients that experienced post LP headache. Conclusions: While acute and transient elevation of intra-ocular pressure has been associated with a condensation of neuroretinal rim, prelaminar tissue, and LC, without major changes in the optic disc size and position of the anterior LC surface, acute significant reduction of CSF-P was not associated with any morphological changing in neither ONH nor LC position.

PURPOSE. To evaluate the safety and efficacy of high-intensity focused ultrasound (HIFU) cyclocoagulation in reducing intraocular pressure (IOP) in patients with refractory glaucoma by using a novel miniaturized delivery device (EyeOP1). METHODS. We conducted a 12-month open-label multicenter prospective study (EyeMUST1 Study). Patients with primary (primary open-angle glaucoma [ POAG]) or secondary refractory glaucoma were treated in two groups depending on the duration of each ultrasound shot (group 1: 4 seconds; group 2: 6 seconds). The primary efficacy outcome was based on IOP reduction at 6 and 12 months. RESULTS. Fifty-two patients were enrolled: 36 (69%) had POAG and 16 (31%) had secondary glaucoma. Group 1 (n = 24) and group 2 (n = 28) had similar demographics and baseline characteristics. In group 1, IOP was reduced from a mean preoperative value of 29.7 +/- 7.7 mm Hg (n = 3.5 glaucoma medications) to a mean postoperative value of 21.3 +/- 6.7 mm Hg (n = 3.5 glaucoma medications) and 20.1 +/- 6.7 mm Hg (n = 3.2 glaucoma medications) at 6 and 12 months, respectively. In group 2, IOP was reduced from a mean preoperative value of 29.0 +/- 7.4 mm Hg (n = 3.3 glaucoma medications) to a mean postoperative value of 20.2 +/- 7.4 mm Hg (n = 3.4 glaucoma medications) and 18.5 +/- 6.6 mm Hg (n = 3.5 glaucoma medications) at 6 and 12 months, respectively. At 12 months, the IOP reduction was sustained in both groups (32% IOP reduction in group 1 and 36% IOP reduction in group 2). The overall tolerance of the technique was good, with no serious adverse events. CONCLUSIONS. The new miniaturized HIFU EyeOP1 delivery device seems to be effective in decreasing IOP in patients with refractory glaucoma. The technology offers a good safety profile.

International audience; Purpose: To evaluate the efficacy and safety of the Ultrasonic Circular Cyclo Coagulation (UC3) procedure with one year of follow-up. Methods: Prospective non comparative interventional clinical study performed in 9 French glaucoma centers. Fifty-two eyes of 52 patients with open-angle glaucoma, intraocular pressure (IOP) > 21 mmHg, an average of 1.7 failed previous surgeries and an average of 3.7 hypotensive medications were insonified with a therapy probe comprising 6 piezoelectric transducers. The 6 transducers were activated, 24 patients (group 1) were treated with a 4 seconds exposure time for each shot and 28 patients (group 2) with a 6 seconds exposure time. Complete ophthalmic examinations were performed before the procedure, and at 1 day, 1 week, 1, 2, 3, 6 and 12 months after. Primary outcomes were surgical success (defined as IOP reduction from baseline ≥ 20% and IOP > 5mmHg) at the last follow-up visit, and vision-threatening complications. Secondary outcomes were mean IOP at each follow-up visits compared to baseline, medication use, complications, and re-interventions. Results: IOP was significantly reduced in both groups (p20%) was achieved in 63.2% of eyes of the group 1 and 44% of eyes of the group 2 at last follow-up. Seven patients were ret-treated. No major intra- or post-operative complications occurred. Conclusions: Ultrasonic Circular Cyclo Coagulation seems to be an effective and well-tolerated method to reduce intraocular pressure in patients with OAG. We found a lower efficacy with the higher dose.

Several clinical and experimental studies have demonstrated that ocular surface disease is common in glaucoma patients receiving chronic glaucoma drops, and that the preservatives in these drops play a major role in the occurrence of ocular surface disease. These ocular surface changes may induce both symptoms reported by the patients and anterior segment clinical signs, and should be systematically assessed by history and exam in all glaucoma patients. In these patients with ocular surface disease, reducing the amount of preservatives administered to the eye should be strived for, rather than adding additional eye drops to alleviate or mask the side effects of the glaucoma drops. (C) 2014 Elsevier Masson SAS. All rights reserved.

Purpose To evaluate the efficacy and safety of the Ultrasonic Circular Cyclo Coagulation (UC3) procedure in patients with primary open-angle glaucoma (POAG). Methods Prospective multicenter clinical trial. 42 eyes of 42 patients with POAG, intraocular pressure (IOP) > 21 mmHg, an average of 1.65 failed previous surgeries and an average of 3.2 hypotensive medications were insonified with a probe comprising 6 piezoelectric transducers. 18 patients (group 1) were treated with a 4 seconds exposure time for each shot and 24 patients (group 2) with a 6 seconds exposure time. Follow-up visits were performed at 1 day, 1 week, 1, 2, 3, 6 and 12 months after Results IOP was significantly reduced in both groups (p20%) was achieved in 12 of 18 (67%) eyes of the group 1 and in 17 of 24 (71%) eyes of the group 2. Four patients were re-treated. No major intra- or post-operative complications occurred. Conclusion UC3 seems to be an effective and well-tolerated method to reduce intraocular pressure in patients with POAG.

International audience; Purpose To evaluate the efficacy and safety of the Ultrasonic Circular Cyclo Coagulation (UC3) procedure in patients with primary open-angle glaucoma (POAG). Methods Prospective multicenter clinical trial. 42 eyes of 42 patients with POAG, intraocular pressure (IOP) > 21 mmHg, an average of 1.65 failed previous surgeries and an average of 3.2 hypotensive medications were insonified with a probe comprising 6 piezoelectric transducers. 18 patients (group 1) were treated with a 4 seconds exposure time for each shot and 24 patients (group 2) with a 6 seconds exposure time. Follow-up visits were performed at 1 day, 1 week, 1, 2, 3, 6 and 12 months after. Results IOP was significantly reduced in both groups (p20%) was achieved in 12 of 18 (67%) eyes of the group 1 and in 17 of 24 (71%) eyes of the group 2. Four patients were re-treated. No major intra- or post-operative complications occurred. Conclusion UC3 seems to be an effective and well-tolerated method to reduce intraocular pressure in patients with POAG.

PURPOSE: To evaluate known and potential risk factors, including nutritional, lifestyle and environmental factors, differentiating patients with high-tension primary open-angle glaucoma (POAG) from control subjects with ocular hypertension (OHT). METHODS: In 2006-2007, 111 French ophthalmologists prospectively enrolled 339 cases of POAG and 339 age-matched controls with OHT. After a clinical examination with assessment of ocular risk factors, the ophthalmologist filled, during face-to-face interview, a detailed questionnaire developed by nutritionists and epidemiologist on lifestyle and environmental risk factors, including socio-demographic variables, dietary habits related to omega-3 fatty acids intake, smoking and alcohol drinking and professional exposure to pesticides and other chemicals. Associations of POAG with risk factors were estimated using conditional logistic regression, with adjustment for age, gender and duration of disease. RESULTS: In the final multivariate model, by comparison with OHT, POAG was significantly associated with more frequent use of pesticides during the professional life [OR = 2.65, 95% confidence interval (CI): 1.04-6.78, p = 0.04] and with low consumption of fatty fish (OR = 2.14, 95% CI: 1.10-4.17, p = 0.02) and walnuts (OR = 2.02, 95% CI: 1.18-3.47, p = 0.01). POAG was also associated with higher frequency of heavy smoking (40 pack-years or more, OR = 3.93, 95% CI: 1.12-13.80, p = 0.03) but not with moderate (20-40 pack-years) and light smoking (

Patient/physician "Bond" in the management of glaucoma. annual meeting of the association-for-research-in-vision-and-ophthalmology (ARVO)

International audience

Purpose: To validate a glaucoma-specific health-related quality of life (HRQoL) questionnaire: the Glau-QoL©. Methods: Patients with ocular hypertension (OHT) or glaucoma took part in a cross-sectional psychometric validation study (n = 573) and a separate reproducibility study (n = 244). Patients answered the 36-item Glau-QoL©, designed from in-depth patient interviews. Results: The clinical validity of the Glau-QoL© was excellent and clearly demonstrated that as disease severity and visual field impairment increased, HRQoL scores for the Psychological Wellbeing, Self-image, Daily Life, Driving, Anxiety and Burden of Treatment domains were negatively affected. Increased age and lower visual acuity were also associated with lower HRQoL scores, although to a lesser extent than the previously mentioned criteria. Worsening of HRQoL domains correlated with the clinical stage of glaucoma: Anxiety and Burden of Treatment scores dropped noticeably when patients were first diagnosed and started treatment, followed by a decrease in scores for Driving, Daily Life, Psychological Wellbeing, and Self-image as clinical conditions worsened. Psychometric validation showed acceptable convergent and discriminant validity of the Glau-QoL©, and good reproducibility, with intraclass correlation coefficients (ICC) and concordance correlation coefficients (CCC) ≥ 0.69. Internal consistency reliability was high (Cronbach's α coefficients > 0.70) for the Daily Life, Psychological Wellbeing, Burden of Treatment and Driving domains; acceptable (coefficients of 0.65 and 0.68, respectively) for the Self-image and Anxiety domains; and weak (coefficient = 0.58) for the Confidence in Health Care domain. Conclusions: The Glau-QoL© questionnaire is a valid and specific HRQoL instrument that demonstrates excellent correlations with disease progression in patients with glaucoma and/or OHT.

Objectives: To evaluate satisfaction and compliance in glaucoma and ocular hypertensive patients receiving a fixed combination treatment. Materials and methods: After instilling a fixed combination, patients were asked to fill out a questionnaire about their satisfaction and compliance at baseline and 15 days after the onset of new therapy. Results: 1693 glaucoma patients (G) and 621 ocular hypertensive (OHT) patients were included. Mean age was 65.6±11.7 years. Onset of disease was 7.2±6.6 years and 5.2±4.9 years for G and OHT patients, respectively. Insufficient efficacy of the previous topical treatment (monotherapy in 55 % of cases) was the main cause for shifting to a fixed combination in 70 % of cases. Satisfaction was increased in 15 % of the patients and compliance was increased in 25 % of the patients. Discussion: Fixed combination provides an easier regimen and therefore encourages better compliance, a key issue in a chronic disease such as glaucoma., But : Évaluer la satisfaction et l’observance de patients glaucomateux et hypertones après mise en place d’une bithérapie fixe par voie locale. Matériels et méthodes : Après instauration d’une bithérapie fixe, un questionnaire portant sur la satisfaction et l’observance a été remis à chacun des patients inclus dans cette étude prospective à la mise en route et 15 jours après l’instauration d’une bithérapie fixe. Résultats : Mille six cent quatre-vingt-treize patients glaucomateux (GAO) et 621 patients hypertones (HTIO) ont été inclus. L’âge moyen était de 65,6 ± 11,7 ans. L’ancienneté de la maladie était respectivement de 7,2 ± 6,6 ans et de 5,2 ± 4,9 ans pour le groupe GAO et HTIO. L’inefficacité du traitement antérieur (une monothérapie dans 55 % des cas) motivait le recours à la bithérapie fixe dans 70 % des cas. L’augmentation du nombre de patients satisfaits a été de 15 % alors que l’observance a été améliorée chez plus de 25 % des patients. Discussion : La bithérapie fixe permet en simplifiant le traitement local une meilleure observance avec une satisfaction accrue chez les patients traités pour glaucome à angle ouvert ou hypertonie oculaire.

Aim: To evaluate the efficacy and safety of a stainless steel miniature glaucoma drainage device (Ex-PRESS R50) for the surgical treatment of primary open angle glaucoma (POAG) and cataract when combined with phacoemulsification. Methods: Clinical, prospective, multicentre, single treatment arm, non-randomised, non-masked study. The Ex-PRESS device was implanted at the limbus under a conjunctival flap. Phacoemulsification cataract extraction and in the bag IOL implantation were performed through clear cornea temporally. Primary outcome: IOP change; secondary outcomes: side effects and VA changes. Results: 26 eyes of 25 patients were implanted with the device. The mean (SD) follow up was 23.9 (10.4) months and the mean age was 75.1 (7.1) years. 17/26 eyes have more than 3 years of follow up. One case was discontinued because of device removal, one because of death, and three were lost to follow up. Efficacy: preoperative IOP was 21 (4) mm Hg; at 1, 2, and 3 years IOP was 15.3 (3.1) mm Hg (35% reduction), 16.6 (2.7) mm Hg (29% reduction), and 16 (2.6) mm Hg (22% reduction) respectively. Kaplan-Meyer determined overall success rate (IOP ⩽21 mm Hg at the last visit with or without medications) as 76.9%. The number of antiglaucoma medications was reduced by 95% at year 1. Only six patients (23%) were taking IOP lowering treatment at their last visit, five with one medication and one with two medications. Side effects: early postoperative complications were clinically mild and included six cases of hypotony (IOP Conclusions: The Ex-PRESS implant, combined with phacoemulsification cataract extraction, is clinically safe and effective, maintaining in the long term a large reduction in IOP and in the number of antiglaucoma medications.