Glaucome et hypertonie oculaire : importance de la pression intraoculaire cible dans la prise en charge thérapeutique en France

National audienceSeveral recent clinical studies have shown the benefit of lowering intraocular pressure in both ocular hypertensive and glaucoma patients. However, in patients with open-angle glaucoma (OAG) or ocular hypertension (OHT), there is no consensus on the value of intraocular pressure (IOP) to be reached to prevent the progression of visual field defects. This IOP value, called target IOP, is defined by the ophthalmologist according to the patient and the progression of the disease, without a clear explicit justification of this decision. In France, ophthalmologists' education is mainly based on scientific meetings and the European Guidelines. This study was conducted to investigate the position of the IOP target in the treatment strategy for patients with glaucoma or OHT. Material and methods: A cross-sectional descriptive survey was conducted in France among ophthalmologists in private practice. Patients with simple OHT or with OAG who required an initiation or a modification of treatment were included. We included 1735 patients (805 males, 46.4%) in the study. An OAG was diagnosed in 1338 patients (77.1%) and a simple OHT in 397 patients (22.9%). The patients with OAG were older than the OHT patients (65 years vs 61.7 years, p<0.0001). Most patients (73.5%) were included for treatment modification (77.5% of the patients with OAG and 59.9% of the patients with simple OHT; p<0.0001). The main reason for treatment change was an unsatisfactory IOP value. The main therapeutic objective was to reach a target IOP in 46.0% of the patients. The choice of the ocular hypotensive drugs depended on the IOP value in 51.9% of the patients. When the treatment was modified, monotherapy was preferred in 60.8% of the patients. Among ophthalmologists, the main objective for the treatment of patients with simple OHT or with OAG was to reach a target IOP. About half the participants were used to set up a target pressure for their patients. This fairly good ratio shows the comprehensiveness and the adaptation of our colleagues to relatively new concepts in treating and managing patients with ocular hypertension or chronic open-angle glaucoma. If a modification in the treatment was necessary, then monotherapy was preferred. This decision was motivated by the efficacy of the treatment but also by expected better patient compliance

Inter-population differences and seasonal dynamic of the bacterial gut community in the endangered land snail Helix pomatia (Gastropoda : Helicidae)

Among the multifaceted environmental factors, the bacterial community ingested with soil and food might play an important role in physiological processes of terrestrial gastropods, with consequences on population dynamics and species distribution patterns. Therefore, we investigated the bacterial gut community structure and seasonal dynamic in three populations of the protected endangered land snail Helix pomatia. The PCR-DGGE fingerprinting analysis followed by Nonmetric Multidimensional Scaling (NMDS) showed that Gamma- and Alphaproteobacteria were common to all populations, while Mollicutes and Betaproteobacteria were population specific. Allochthonous strains might be transiently abundant in the gut of foraging snails with respect to habitat conditions. Autochthonous strains were permanently present in the gut, even after expulsion of the gut content at hibernation beginning. Some of these permanent strains are known to have ice-nucleating activity, which is consistent with the limited cold hardiness in this species. Snails that did not enter hibernation despite being exposed to winter conditions had a poor bacterial community. In conclusion, the bacterial community structure differed between habitats and physiological states, and might be important for physiological processes and survival. Further studies should focus on the individual variation in bacterial community and investigate how it is affected by environmental changes