Total IgE and eotaxin (CCL11) contents in tears of patients suffering from seasonal allergic conjunctivitis.

BACKGROUND: To prospectively investigate patients with seasonal allergic conjunctivitis (SAC) during the pollen season and test associations between tears total IgE, eotaxin concentrations, and SAC severity. METHODS: Enrolled patients presented ocular symptoms and clinical signs of SAC at the time of presentation. Ocular itching, hyperaemia, chemosis, eyelid swelling, and tearing were scored, and the sum of these scores was defined as the clinical score. Conjunctival papillae were separately graded. We measured eotaxin concentration in tears by an enzyme-linked immunosorbent assay (ELISA) and total tear IgE by Lacrytest strip. RESULTS: Among thirty patients (30 eyes), 11 showed neither tear IgE nor tear eotaxin, while 15 out of 19 patients with positive IgE values presented a positive amount of eotaxin in their tears (Fisher's test: p < 0.001). The mean eotaxin concentration was 641 ± 154 (SEM) pg/ml. In patients with no amount of tear IgE, we observed a lower conjunctival papilla grade than in patients whose tears contained some amount of IgE (trend test: p = 0.032). In the 15 patients whose tear eotaxin concentration was null, tear IgE concentration was 5.3 ± 3.5 arbitrary units; in the other 15 patients whose eotaxin was positive, IgE reached 21 ± 4.3 arbitrary U (Mann-Whitney: p < 0.001). We measured 127 ± 47 pg/ml eotaxin in patients with no history of SAC but newly diagnosed as suffering from SAC, and 852 ± 218 pg/ml eotaxin in patients with a known SAC (p = 0.008). In contrast, tear IgE concentrations of both groups did not differ statistically significantly (p = 0.947). CONCLUSIONS: If IgE and eotaxin secreted in tears are major contributors in SAC pathogenesis, they however act at different steps of the process

Les surélévations: solution pour endiguer la crise du logement à Genève ?

Le canton de Genève vit une situation de pénurie dans le marché immobilier depuis plusieurs dizaines d’années maintenant. Les gouvernements successifs n’ont pas réussi à endiguer cette crise qui ne se dirige pas vers une amélioration. Les milieux politiques sont toujours très concernés lorsqu’il s’agit de logements, les débats sont fréquents entre les différentes parties impliquées, parmi lesquelles figurent les propriétaires et les locataires. Chacun défend ses intérêts avec une telle véhémence que cela engendre un réel blocage. De multiples couches rendent la lecture légale de la problématique extrêmement difficile pour un oeil non aguerri. Des lois cantonales et fédérales sont impliquées pour fixer les règles à respecter en la matière. La difficulté étant que le canton n’a que très peu d’influence sur les lois établies par la Confédération. Pour une majorité des acteurs ce sont pourtant quelques éléments de loi, qui en étant modifiés, permettraient une détente du marché immobilier genevois. La situation actuelle est d’autant plus délicate qu’il ne reste au canton que très peu de terres sur lesquelles il est autorisé à construire. Une piste de réflexion pourrait être de trouver la meilleure façon de construire du logement en ayant recours au minimum de terrain. La surélévation d’immeubles, qui a l’immense avantage de ne pas être consommatrice de surface au sol, est une alternative crédible pour le canton afin de répondre à la demande en logement des habitants. Cette solution, en théorie prometteuse sur le canton de part cette caractéristique et le fait que le canton soit relativement bien urbanisé, ne suffira cependant pas, à elle seule, à régler la crise immobilière actuelle. Ce travail porte sur le contexte des surélévations à Genève avec notamment une comparaison entre la construction d’un immeuble et la réalisation de deux surélévations

Ophtalmologie. Rétinopathie diabétique: nouvelles possibilités thérapeutiques [Diabetic retinopathy: new therapeutic possibilities].

La rétinopathie diabétique touche un nombre croissant de personnes, soit quatre millions en Europe, ce chiffre va probablement doubler d'ici 2030. Si l'on considère que 25-30% de ces patients sont atteints de rétinopathie diabétique, un dépistage et un traitement précoce permettent d'éviter les complications oculaires sévères telles que l'oedème maculaire cystoïde où la rétinopathie diabétique proliférative. Un résumé des dernières données de la littérature ophtalmologique est présenté en insistant sur le rôle de l'anti-VEGF (vascular endothelial growth factor) et des implants intravitréens de corticostéroïdes pour une pathologie oculaire récemment classée dans les pathologies inflammatoires. Diabetic retinopathy affects an increasing number of persons, about 4 millions in Europe, a number that will probably double until 2030. If we consider that 25-30% of patients are affected by diabetic retinopathy, an ophthalmologic screening and early therapy will allow a better visual prognosis and avoid severe ocular complications such as diabetic macular edema and proliferative diabetic retinopathy. A summary of current ophthalmologic literature was performed and was focused on the role of anti-VEGF (vascular endothelial growth factor) therapies and intraocular drug delivery of corticosteroids in a pathology that was recently classified in inflammatory pathologies

Anterior segment granuloma and optic nerve involvement as the presenting signs of systemic sarcoidosis

Marilita M Moschos1, Yan Guex-Crosier21Department of Ophthalmology, University of Athens, Athens, Greece; 2Jules Gonin Eye Hospital, University of Lausanne, Lausanne, SwitzerlandPurpose: To report a case with anterior and posterior nodules associated with systemic sarcoidosis.Methods: A patient with decreased vision underwent complete ophthalmologic examination, ultrasound biomicroscopy, fluorescein and indocyanine green (ICG) angiography.Results: The patient presented a nodule of the iris of the OS and of the optic nerves of both eyes. Chest computed tomography and tissue biopsy established the diagnosis.Conclusions: Fluorescein and ICG angiography are the only objective exams to demonstrate the extent of ocular involvement in a patient with sarcoidosis.Keywords: sarcoidosis, fluorescein angiography, indocyanine angiograph

Giant cell arteritis: A rare cause of posterior vasculitis

PURPOSE: To report three cases of posterior vasculitis associated with subacute giant cell arteritis (GCA). METHODS: Three patients with decreased vision underwent complete ophthalmologic examination and fluorescein angiography. RESULTS: All patients presented posterior vasculitis. Patient 1 had an erythrocyte sedimentation rate (ESR) of 38 mm/hr and a C-reactive protein (CRP) of 28mg/L. Patient 2 and 3 had an ESR of 104 and 95 mm/hr and a CRP of 42 and 195 mg/L accordingly. Diagnosis was established by temporal artery biopsy. Resolution was observed after systemic prednisolone therapy. CONCLUSION: GCA should be suspected when posterior vasculitis and relatively high ESR and CRP are present

A cross-sectional study of submacular thickening in intermediate uveitis and determination of treatment threshold.

The aim of this work is to refine understanding of anatomical and functional alterations in eyes with Intermediate Uveitis (IU), their natural history in mild cases not necessitating treatment and their response to treatment in severely affected eyes with macular edema. 61 consecutive patients with IU presenting over a 6-year period were prospectively recruited into the study. Two subgroups of patients with IU were identified on the basis of the need or not for systemic cortico-steroid treatment. A group of healthy volunteers was identified for determining normal average central foveal thickness (CFT) values. Statistical comparisons were sought between patient sub-groups and with the group of normal volunteers for CFT and Best Corrected Visual Acuity (BCVA) at baseline and after 6 months. In a post hoc analysis, a cut-off value of CFT for systemic treatment initiation in IU was statistically identified and its sensitivity and specificity determined. A statistically significant difference in mean CFT at baseline was observed between patients under systemic treatment and untreated patients (p = 0.0005) as well as between untreated patients and healthy volunteers. (p < 0.001) After six months difference in CFT between the two patients subgroups was no longer significant (p = 0.699). BCVA was worse for patients under systemic treatment. No statistically significant difference could be identified between the subgroup of untreated patients and the group of healthy volunteers either at baseline or after 6 months. Correlation between LogMAR visual acuity and central retinal thickness at baseline was strong (r = 0.7436, p < 0.0001, Pearson's correlation coefficient). The cut-off value of CFT for initiating systemic treatment was determined at 215.5 μm in a post hoc analysis (sensitivity 62.5 %, specificity 96.4 %). Subclinical retinal thickening of mildly inflamed eyes with IU can occur though bearing no functional clinical significance and spontaneously resolving within 6 months. A cut-off CFT value for treatment of macular edema in IU, in the presence of other relevant morphological features on Optical Coherence Tomography, seems to emerge from post hoc analysis of collected data demonstrating strong specificity and moderate sensitivity

Total IgE and eotaxin (CCL11) contents in tears of patients suffering from seasonal allergic conjunctivitis

Background: To prospectively investigate patients with seasonal allergic conjunctivitis (SAC) during the pollen season and test associations between tears total IgE, eotaxin concentrations, and SAC severity. Methods: Enrolled patients presented ocular symptoms and clinical signs of SAC at the time of presentation. Ocular itching, hyperaemia, chemosis, eyelid swelling, and tearing were scored, and the sum of these scores was defined as the clinical score. Conjunctival papillae were separately graded. We measured eotaxin concentration in tears by an enzyme-linked immunosorbent assay (ELISA) and total tear IgE by Lacrytest strip. Results: Among thirty patients (30 eyes), 11 showed neither tear IgE nor tear eotaxin, while 15 out of 19 patients with positive IgE values presented a positive amount of eotaxin in their tears (Fisher's test: p < 0.001). The mean eotaxin concentration was 641 ± 154 (SEM) pg/ml. In patients with no amount of tear IgE, we observed a lower conjunctival papilla grade than in patients whose tears contained some amount of IgE (trend test: p = 0.032). In the 15 patients whose tear eotaxin concentration was null, tear IgE concentration was 5.3 ± 3.5 arbitrary units; in the other 15 patients whose eotaxin was positive, IgE reached 21 ± 4.3 arbitrary U (Mann-Whitney: p < 0.001). We measured 127 ± 47pg/ml eotaxin in patients with no history of SAC but newly diagnosed as suffering from SAC, and 852 ± 218pg/ml eotaxin in patients with a known SAC (p = 0.008). In contrast, tear IgE concentrations of both groups did not differ statistically significantly (p = 0.947). Conclusions: If IgE and eotaxin secreted in tears are major contributors in SAC pathogenesis, they however act at different steps of the process

Fluorescein and indocyanine-green angiography in ocular syphilis: an exploratory study

Background: Fluorescein (FA) and indocyanine-green angiography (ICGA) may offer valuable information concerning disease severity and prognosis in ocular syphilis. The aim of the present study is to describe angiographic patterns encountered in the context of ocular syphilis, and to explore the associations between specific angiographic manifestations and severity of disease presentation, as well as disease evolution after treatment. Methods: We performed a retrospective institutional study with the inclusion of 23 patients with ocular syphilis presenting to the uveitis clinic of the Jules-Gonin Eye Hospital in a 10-year period. FA and ICGA were performed following a standard protocol for posterior uveitis. Patterns of fluorescence were noted, and statistical associations between each angiographic pattern and any demographic, clinical, or laboratory parameter at baseline and after treatment were sought. Results: The presence of any dark dots in ICGA was significantly associated with anterior uveitis (p = 0.031). The presence of hot spots in ICGA was significantly associated with longer duration of symptoms prior to initial visit (p = 0.032) and with male gender (p = 0.012). Weak non-significant trends were found associating vascular staining in FA with anterior uveitis (p = 0.066), vitritis (p = 0.069), and younger age (p = 0.061), as well as disc hyperfluorescence in FA with seropositivity for HIV (p = 0.089) and macular edema in FA with longer disease duration (p = 0.061). The presence of any dark dots in ICGA exhibited a weak trend of association with anterior uveitis and/or vitritis (p = 0.079). Conclusions: Out of the several associations identified implicating specific angiographic features, we underline the possible role of the presence of dark dots in ICGA for identifying active inflammation, and the role of hot spots in ICGA as markers of long-standing disease. Vascular staining in FA appears to be more common in patients with severe ocular inflammation with presence of anterior uveitis and/or vitriti