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"Pierre-Yves, Robert"
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Lost kingdoms : Hindu-Buddhist sculpture of early Southeast Asia /
\"Numerous Hindu and Buddhist kingdoms flourished in Southeast Asia from the 5th to the 9th century, yet until recently few concrete details were known about them. Lost Kingdoms reveals newly discovered architectural and sculptural relics from this region, which provide key insights into the formerly mysterious kingdoms. The first publication to use sculpture as a lens to explore this period of Southeast Asian history, Lost Kingdoms offers a significant contribution and a fresh approach to the study of cultures in Cambodia, Thailand, Burma, and other countries\"--Distributor's website.
Book
The myofibroblast, biological activities and roles in eye repair and fibrosis. A focus on healing mechanisms in avascular cornea
Tissue healing is one of the mysteries of modern medicine. Healing involves complex processes and many cellular types, amongst which the myofibroblast plays a major role. In the eye, when needed, myofibroblasts can be found from the cornea to the retina, derived from a wide variety of different cells, and aimed at effectively repairing tissue damage. Myofibroblast differentiation requires transforming growth factor (TGF)-β1, the presence of specific extracellular matrix components such as the ED-A domain of fibronectin, and mechanical tension. Control of this process may, in some cases, be abnormal leading to development of fibrotic tissue, which alters and compromises the integrity of the original tissue. The eye is no exception to this rule with normal visual function, a highly demanding process, only possible in a fully integrated organ. The cornea, a transparent protective tissue and first dioptre of the eye, has the particularity of being entirely avascular and very richly innervated under normal physiological conditions. However, these anatomical features do not prevent it from developing myofibroblasts in the event of a deep corneal lesion. Activated by growth factors such as TGF-β1 and platelet-derived growth factor from the aqueous humour, tears or corneal epithelial cells, myofibroblasts can cause corneal scarring, sometimes with devastating consequences. Understanding the factors involved in healing and its signalling pathways, will potentially enable us to control corneal healing in the future, and thus avoid fibrotic ocular surface disease and the blindness that this may induce. Currently, this issue is the subject of very active research and development with the aim of discovering new antifibrotic therapies.
Journal Article
Class II Human Leukocyte Antigen (HLA) and Susceptibility to Polypoidal Choroidal Vasculopathy in Afro-Caribbean Descent
To evaluate how the HLA genotype is associated to the polypoidal choroidal vasculopathy (PCV) in a population of patients of Afro-Caribbean descent.
Forty-seven patients were diagnosed with PCV. The number of control patients was 457. All affected patients and control patients were of Afro-Caribbean descent and natives to Martinique. HLA typing was based on blood sample, using the polymerase chain reaction technique. Comparison of HLA alleles between the 2 groups was done using chi-2 test, odds ratio (OR) and confidence interval using Woolf's method. The Bonferroni correction was considered significant when p-value ≤0.05. Alleles frequency was analyzed for DRB1 and DQB1 locus.
HLA-DRB1*13 allele was significantly associated to PCV (OR = 2.02, CI = [1.3; 3.13], p = 0.003). In group DRB1, the Bonferroni correction significance threshold was <0.004. HLA-DQB1*04 allele was significantly associated to PCV (OR = 3.5, CI = [1.48; 8.3], p = 0.006). In group DQB1, the Bonferroni correction significance threshold was <0.006.
Two HLA alleles are positively associated to PCV. The possible association between PCV and certain alleles suggest HLA implication in PCV pathogeny, most likely by modeling the immune system response.
Journal Article
Systemic exposure to intracameral vs topical mydriatic agents: in cataract surgery
The objective of this study was to compare systemic exposure to tropicamide/phenylephrine following intracameral or topical administration before cataract surgery.
Mydriatics exposure was calculated in patients randomized to intracameral fixed combination of mydriatics and anesthetic ([ICMA]: tropicamide 0.02%, phenylephrine 0.31%, and lidocaine 1%, N=271) or mydriatic eye drops ([EDs]: tropicamide 0.5% and phenylephrine 10%, N=283). Additional doses were permitted if required. Mydriatic plasma levels were determined by mass spectrometric HPLC in 15 patients per group before and after administration.
Most ICMA patients (73.6%) received a single dose (200 µL) representing an exposure to tropicamide of 0.04 mg and phenylephrine of 0.62 mg. None of these patients received additional mydriatics. In the control group (three administrations), the exposure was 0.45 (11.3-fold higher than ICMA) and 10.2 (16.5-fold higher) mg. When additional ED was used in this group (9.2% of patients), it was 37.5-fold higher for tropicamide (10 drops, 1.5 mg) and 54.8-fold higher for phenylephrine (10 drops, 34 mg) than the recommended ICMA dose. Tropicamide plasma levels were not detectable at any time point in ICMA patients while it was detectable in all ED patients at 12 and 30 minutes. Phenylephrine was detectable in 14.3% of ICMA patients compared to all ED patients at least at one time point. More ED patients experienced a meaningful increase in blood pressure and/or heart rate (11.2% vs 6.0% of ICMA patients;
=0.03).
Systemic exposure to tropicamide/phenylephrine was lower and cardiovascular (CV) effects were less frequent with ICMA. This could be of particular significance in patients at CV risk.
Journal Article
French public care in ophthalmology: a nationwide survey
AimTo describe the medical resources in ophthalmology departments of French public hospitals and to suggest what training needs could be relevant for the future.MethodsAn online survey was emailed to heads of ophthalmology departments in French public hospitals, including both general and university hospitals. The questionnaire included data on the ophthalmological emergency services, the demographics and the subspecialties declared by practitioners. Data were statistically analyzed geographically, across administrative areas, in university and non-university hospitals.ResultsOne hundred and forty-five centers replied to the questionnaire, representing 823 ophthalmologists, of whom 408 were men (49.6%). The mean age of ophthalmologists was 42.4 ± 5.3 years, with 57% of the physicians being under 40 years old and 14% over 60 years old. The medical positions were distributed as follows: hospital practitioners ( n = 335; 40.7%), mixed practitioners ( n = 179; 21.7%), fellows ( n = 156; 18.9%), university fellows ( n = 75; 9.1%), professors ( n = 63; 7.7%), and associate professors ( n = 15; 1.8%). The mean density of public ophthalmologists was 1.37 per 100,000 inhabitants (range: 0–8.4). The distribution of ophthalmologists across the country was characterized by a notable representation of subspecialties such as retina, glaucoma, and cataract surgery. However, the distribution of ophthalmologists specializing in neuro-ophthalmology and ocular inflammation exhibited significant variability.ConclusionThis study highlights significant geographical disparities in the distribution of public ophthalmological care in France, especially in neuro-ophthalmology and ocular inflammation. This preliminary work will facilitate the adjustment of the number of practitioners in public hospitals according to the population’s requirement for eye care.
Journal Article
Practice patterns in the management of bacterial keratitis: a five-continent survey
PurposeTo assess the current diagnostic and therapeutic practice patterns in early management of bacterial keratitis over five continents.MethodsBetween March and August 2019, we distributed an online survey including two clinical scenarios of bacterial keratitis, namely, a mild case and severe case, to 2936 ophthalmologists from 144 countries around the world. The survey consisted of 29 questions. We performed descriptive statistics and a comparative analysis of the answers according to the participants’ continent of practice, practice setting, seniority, and subspecialty.ResultsWe received 237 surveys from 54 countries (8% response rate). The proportion of respondents performing microbiological investigations was higher in North America, Asia, Europe, and Oceania than Africa and South America (p < 0.05). This ratio was also higher among ocular surface specialists than for other ophthalmologists (p < 0.001). For mild cases, fluoroquinolone monotherapy and a combination of two or more antibiotics were prescribed by 46% and 41% respondents, respectively. For severe cases, fluoroquinolone monotherapy and a combination of antibiotics were prescribed by 20% and 78% respondents, respectively. Fluoroquinolone monotherapy was the most commonly prescribed treatment in South America, Africa, and Oceania. A combination of two antibiotics was preferentially prescribed in the rest of the world. Topical steroids were prescribed in both circumstances, respectively, in 72% and 75% of cases.ConclusionOur results highlight essential geographical disparities in the current management of bacterial keratitis over five continents.
Journal Article
Efficacy and safety of short duration azithromycin eye drops versus azithromycin single oral dose for the treatment of trachoma in children: a randomised, controlled, double-masked clinical trial
Aims: Efficacy and safety of a short-duration treatment of azithromycin 1.5% eye drops versus oral azithromycin to treat active trachoma. Methods: Randomised, controlled, double-masked, double-dummy, non-inferiority explanatory study including 670 children from Guinea Conakry and Pakistan if: 1–10 years old; active trachoma (TF+TI0 or TF+TI+ on simplified World Health Organisation (WHO) scale). Three groups received either: azithromycin 1.5% eye drops twice daily for 2 days, for 3 days or azithromycin single 20 mg/kg oral dose. Patients’ contacts were treated whenever possible. Clinical evaluation was performed using a binocular loupe. Primary efficacy variable was the cure (no active trachoma (TF0)) at day 60. Non-inferiority margin for difference between cure rates was 10%. Results: Cure rate in per protocol set was as follows: 93.0%, 96.3% and 96.6% in 2-day group 3-day group, and oral treatment group, respectively. Azithromycin 1.5% groups were non-inferior to oral azithromycin. The intend to treat (ITT) analysis supported the results. Clinical re-emergence rate was low: 4.2%. Ocular tolerance was similar for all groups. No treatment related adverse events were reported. Logistic regression analyses found prognostic factors such as: country (p<0.001) and trachoma severity (p = 0.003). Conclusions: In active trachoma, azithromycin eye drops twice daily for 2 or 3 days are as efficient as the WHO’s reference treatment and represent an innovative alternative to oral azithromycin.
Journal Article
Ophthalmologic outcome of direct and indirect carotid cavernous fistulas
Carotid cavernous fistulas (CCFs) can be classified as direct and indirect, depending on their flow rates and their etiology. Both forms can cause the same characteristic ophthalmological symptoms and signs. We analyzed these ocular characteristics and determined the prognostics factors associated with treatment outcome. Forty-seven patients with an angiographically confirmed diagnosis of CCF, a preoperative ophthalmic evaluation and at least one ophthalmic sign or symptom at the initial presentation were retrospectively evaluated. The patients were followed-up ophthalmically until the end of treatment, and the complications and the remaining ophthalmological signs and symptoms were then recorded. The patients’ ages ranged from 13 to 89 years, with an average of 55.78 (±20.73) years, and a predominance of 28 female (57.8 %) patients. The patients with a direct CCF had a lower average age (
p
= 0.02). The most common symptoms were blurred vision in 17 (36.2 %) and proptosis in 37 (78.7 %) patients. Elevated intraocular pressure (IOP) was more prevalent in patients with an indirect CCF (
p
= 0.02). Thrill was more prevalent in patients with direct CCF (
p
= 0.01). The presence of an initial decrease of visual acuity at the first ophthalmic evaluation was significantly associated with the persistence of ocular symptoms after fistula treatment (odds ratio 3.33). In conclusion our study shows a slight difference in ophthalmic symptoms among patients with different types of fistula. Elevated IOP was significantly associated with indirect fistulas, whereas thrill was significantly associated with direct fistulas. The presence of an initial decrease of visual acuity was significantly associated with a worse ophthalmic prognosis.
Journal Article
Specific antibody production in herpes keratitis: intraocular inflammation and corneal neovascularisation as predicting factors
The purpose of the study is to investigate whether analysis of specific antibody synthesis can aid the diagnosis of herpes keratitis.
Aqueous humor was collected from 39 patients with presumed recurrent herpes keratitis, including 23 consulting for keratitis and 16 patients scheduled for penetrating keratoplasty. Local antibody production was ascertained by analysis of paired aqueous humor/serum samples, using a modified micro-ELISA technique.
Local production of antibodies was found in 32 patients (82%): anti-herpes simplex virus (HSV) antibodies in 26 (67%) and anti-varicella zoster virus (VZV) antibodies in 11 (28%). Twenty of 23 patients with active keratitis (87%), and 12 of 16 undergoing keratoplasty (75%), tested positive. Five patients had local production of both anti-HSV and anti-VZV antibodies, whereas seven patients tested negative. Local antibody production was significantly associated with intraocular inflammation (P<0.05), corneal neovascularisation (P<0.05), and positive response to anti-viral treatment (P<0.05). No complications were encountered in sampling aqueous humor.
Assessment of local anti-HSV and -VZV antibody production is a safe and reliable diagnostic procedure for recurrent herpes keratitis. It might be particularly helpful in patients presenting with intraocular inflammation and neovascularisation since it discriminates between herpes and non-herpes pathologies and may therefore be useful for preventive and therapeutic strategies.
Journal Article
Retrocaruncular approach to the medial orbit for dacryocystorhinostomy
The objective of this study was to present a versatile approach to the medial orbit behind the caruncula for dacryocystorhinostomy.
This study was a retrospective, non-comparative, case series with a description of the surgical technique. We report 11 procedures carried out on 10 patients, who were operated on for DCR using the retrocaruncular approach (RCDCR). Surgical indications and complications were recorded for every patient.
Lacrimal patency was obtained in 82% of the cases. The average follow-up was 2.81 months (1-6.5).
DCR may be safely completed through a retro-caruncular approach. The retrocaruncular approach provides excellent and safe exposure of the posterior aspect of the lacrimal sac, and it avoids the scarring associated with the skin approach.
Journal Article