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L Laroche

Publications and source records attributed to L Laroche.

At least 55 records · Page 3Linked to original sources
PubMed2003

[Immunosuppression in corneal transplantation].

Rejection is the leading cause of corneal graft failure, induced by loss of the so-called eye immune privilege. Prevention of graft rejection with immunosuppressive therapy is then necessary. Topical corticosteroids are currently the gold standard, and steroids are the only treatment for acute rejection episodes. Steroids are nonspecific immunosuppressive agents, and they can induce glaucoma, cataract, infections, and epithelial defects. Cyclosporin has a specific effect, because it inhibits interleukin-2 transcription and, consequently, the specific activation of T lymphocytes. When cyclosporin is given orally, it effectively prevents graft rejection in high-risk recipients, but it may induce severe side effects (i.e., systemic hypertension, kidney deficiency, and malignant tumor induction). When cyclosporin is given topically, it can effectively replace steroids in case of dexamethasone-induced glaucoma and graft infection, but it can also induce serious corneal epithelial defects. Cyclosporin is not a treatment for acute rejection episodes. Mycophenolate mofetil and FK 506 are promising drugs, but currently they cannot be used routinely to prevent corneal graft rejection.

Adrenal Cortex Hormones↗
PubMed2003

[Treatment of the sequelae of ocular burns using limbal transplantation].

PURPOSE: To report the results of limbal transplantation in patients with severe ocular burns and limbal stem cell deficiency. PATIENTS AND METHODS: This series includes six autografts (unilateral ocular burns) and five allografts (bilateral ocular burns) performed in ten eyes of ten males with an average age of 43 years. The origin of the ocular burn was chemical in eight cases and thermal in the remaining two cases. The average time between the initial trauma and limbal transplantation was 79 months. The average size of limbal grafts was 190 degrees (range: 80-20 degrees for autografts and 120-360 degrees for allografts). Patients with allografts received oral cyclosporine in three cases, topical cyclosporine in one case, and intravenous methylprednisolone in one case. Eight patients underwent penetrating keratoplasty an average of 11 months after limbal transplantation (range: 5-24 months). RESULTS: The average follow-up time was 36 months (range: 7-77 months). The overall success rate of limbal transplantation (ocular surface improvement) was 73% (8/11). The success rate of penetrating keratoplasty was 63% (5/8). The average initial visual acuity was 0.4/10 and the average final visual acuity was 1.6/10. Visual acuity improved by two lines or more in seven cases. DISCUSSION: Limbal transplantation is a useful surgical technique in patients with severe ocular burns. However, results remain insufficient and new techniques such as limbal stem cell culture and transplantation are needed to improve the visual prognosis of these patients.

Adult↗
PubMed2003

[Posterior subcapsular cataract in a case of ulcerative colitis treated with corticosteroid enema].

We report the case of a 65-year-old patient suffering from a long-term ulcerative colitis treated with corticosteroid enema and presenting a bilateral posterior subcapsular cataract. As far as we know, this is the first case report of steroid-induced cataract after intrarectal corticosteroid use. Alternative hypotheses concerning the mechanism of cataract formation are suggested. This case report should warn ophthalmologists and gastroenterologists about the cataractogenic effects of corticosteroid enema to ensure that information is provided for patients suffering from ulcerative colitis.

Anti-Inflammatory Agents↗
PubMed2002

[Evaluation of the quality of life in ophthalmology].

THE IMPORTANCE OF VISUAL FUNCTION IN THE ASSESSMENT OF QUALITY OF LIFE: The notion of visual function is related to visual acuity but also to many other parameters such as the visual field, perception of colour, contrasts, and the resistance to blinding. These factors are difficult to measure during routine ophthalmic examination but can be assessed during questionnaires on quality of life. MARKERS OF QUALITY OF LIFE IN OPHTHALMOLOGY: Various quality of life questionnaires have been developed in ophthalmology because the non-specific generic instruments appear inadequate. The SF 36 and SF 20 scales, which are generic instruments widely used in many fields, do not adequately explore the problems related to vision. The first efficient instrument is the VF 14, which is a questionnaire specific to ophthalmic diseases, developed by C. Mangione in 1992. This self-administered questionnaire permits calculation of a 0 to 100 score exploring 5 dimensions (long-sight acuity, near-sight acuity, unclear sight, and driving during the day and at night) during 14 activities with 18 questions. It was translated and adapted into French by Gresset in 1997. Today it is the most commonly used questionnaire in ophthalmology, particularly in the assessment of efficacy and impact in surgery. Along the other specific questionnaires developed, there is the NEI-VQF which was created in 1995 to assess vision and the impact of visual problems on the quality of life of patients, independently of an ophthalmic pathology. Many studies have been conducted on various diseases that affect vision, such as diabetes or hypertension. THE LIMITS OF EXISTING INSTRUMENTS: The specific scales appear far more sensitive and specific than generic scales with regard to ophthalmic problems, but they provide less information on the general status of the patient, except for the NEI-VQF. They are limited in some parameters and do not, unfortunately, take into account the patient's age. No specific scale has been developed for children or adolescents, although the impact of vision on daily life is fundamental. The complexity of vision means that the elaboration of an ideal instrument is difficult. However, in the meantime, it is essential that the practitioners continue to use and to test the instruments available in order to improve with regard to pathologies, or in particular sub-groups of the population.

Activities of Daily Living↗
PubMed2002

Identification of genetic loci controlling bacterial clearance in experimental Salmonella enteritidis infection: an unexpected role of Nramp1 (Slc11a1) in the persistence of infection in mice.

The Gram-negative bacteria, Salmonella, cause a broad spectrum of clinical diseases in both animals and humans ranging from asymptomatic carriage to life-threatening sepsis. We have developed a model to study the contribution of genetic factors to the susceptibility of 129sv and C57BL/6J inbred mice to Salmonella enteritidis during the late phase of infection. C57BL/6J mice were able to eliminate completely sublethal inoculums of S. enteritidis from their reticuloendothelial system, whereas 129sv mice could not even after 60 days post inoculation. A genome scan performed on 302 (C57BL/6J x 129sv) F2 progeny identified three dominant loci (designated Ses1 to Ses3) that are associated with disease susceptibility in 129sv mice. Two highly significant linkages were identified on chromosomes 1 (Ses1) and 7 (Ses2) with respective LOD scores of 9.9 (P = 1.4 x 10(-11)) at D1Mcg5 and 4.0 (P = 1.9 x 10(-5)) at D7Mit62. One highly suggestive QTL was located on chromosomes15 (Ses3) with a LOD score 3.4 (P = 1.2 x 10(-4)). The estimated effects of Ses1, Ses2 and Ses3 on the bacterial clearance were greater in females. Using a model of three loci, with interaction between Ses1 and Ses2 and sex as a covariate, the three QTLs explained 32% of the phenotypic variance. The candidacy of Nramp1 as the gene for Ses1 was evaluated using mice carrying a null allele at Nramp1 (129sv-Nramp1(tm1Mcg)). These mice have a significantly lower spleen bacterial load compared to the wild-type 129sv mice, strongly suggesting the involvement of Nramp1 in controlling S. enteritidis clearance during the late phase of infection.

Animals↗
PubMed2002

[Clinical evaluation of the ocular safety of Amukine 0.06% solution for local application versus povidone iodine (Bétadine) 5% solution for ocular irrigation) in preoperative antisepsis].

INTRODUCTION: The aim of this monocentric, randomized, comparative, open study was to evaluate the safety of Amukine 0.06% solution (an isotonic hypochloride sodium solution) versus a 5% povidone iodine solution (Bétadine 5% solution for ocular irrigation) in antisepsis before cataract surgery. MATERIAL AND METHODS: One hundred and thirteen patients, aged between 49 and 90 years, were included and split, after randomization, into two groups: one testing Amukine 0.06%, the other testing a 5% povidone iodine solution. For each group, after local anesthesia, the antiseptic procedure consisted of an antisepsis of periocular teguments followed by an eye antisepsis through the instillation of two drops of the tested product in the conjunctival fornices. The safety evaluation was performed by grading superficial punctate keratitis 24 hours after surgery (slit lamp examination after fluorescein instillation). Conjunctival hyperemia scores by examination of the bulbar conjunctiva before the first instillation, immediately before surgery, and 24 hours after surgery were also compared. RESULTS: One hundred and seven reports were analyzed. Concerning the presence of corneal superficial punctate keratitis 24 hours after surgery, mean scores were not different (0.27 for the Amukine 0.06% group and 0.38 for the povidone iodine group; p=0.27 Mann Whitney test). The observations did not show a different progression of conjunctival hyperemia depending on the treatment group (p=0.65 (immediately after application) and p=0.52 (after 24 hours); Mann Whitney test). CONCLUSION: In this study, the ocular safety of Amukine 0.06% solution was not different from a 5% povidone iodine solution. Therefore, Amukine 0.06% is a new interesting approach to surgical antisepsis in ophthalmology and an alternative in case of iodine allergy.

Aged↗
PubMed2002

[Corneal acid burning after facial peeling].

We describe the case of a 66-year-old woman who had previously undergone facial peeling and developed severe bilateral corneal burn due to direct contact Exopeel((R)) with her eyes. Despite medical treatment and an amniotic membrane graft, deep stromal opacity persisted in one eye.

Aged↗
PubMed2002

[Activity and epidemiology in an ophthalmological emergency center].

PURPOSE: To investigate the numbers and characteristics of patients with ophthalmological emergencies presenting at a general hospital. METHODS: Retrospective analysis of ophthalmological emergencies over 11 years included comparison with demographic changes and, over the last 2 years, analysis of the patients treated (age, sex, and pathology, according to 23 preselected pathologies). Ophthalmological examinations were done by a senior ophthalmologist. RESULTS: The activity rose from 396 patients in 1989 to 2,793 in 2000. The prevalence of ophthalmological emergencies in the area was 5.1 per 1,000 residents. The ophthalmological emergency rate compared with all emergencies in a general hospital classified as an Emergency Department Hospital was 5%. The male to female ratio was 1.88, the excess being explained by the higher risk of injury in men (professional and domestic). Of these patients, 28% were under 18 years of age, 43% were between 18 and 40, and 29% were over 40 years old. Most patients were self-referred. Fifty-three percent of the patients were from the hospital's influence sector. Of all ophthalmic patients, 3%-5% were hospitalized, 65% for medical reasons and 35% for surgical and trauma reasons. We pre-listed 23 pathologies to screen our patients, which covered 95% of all the patients examined in the emergency department. These ophthalmological medical emergencies were classified as follows: 20% infections disease, 12.6% ocular inflammation, 0.8% neurophthalmology. Traumatology can be classified as follows: 6.4% ocular burns, 2% electrical arc injuries, 35.3% corneal lesion, 10% injuries of conjunctiva, sclera, corneosclera, lacrimal duct, and 1% perforation of the eyeball. CONCLUSION: There is a real need for ophthalmic emergency services in general hospitals. Benign pathologies not needing diagnosis and adapted treatment were not noted in our study. The cheapest and most efficient way to diagnose these ophthalmic emergencies appeared to be the ophthalmological emergency center with a senior ophthalmologist, according to the regional health organization.

Adult↗
PubMed2002

[Orbscan: a new device for iridocorneal angle measurement].

PURPOSE: To evaluate the accuracy and reproducibility of iridocorneal angle measurement obtained with a slit-lamp method (Orbscan). METHODS: The iridocorneal angle was measured in 100 normal eyes of 50 patients using the Orbscan II device. Angles were measured in eight meridians using both the "plane" and "polynomial" modes. For each eye, two exams were taken successively and the reproducibility was calculated by analyzing the difference between both measurements. Angle value was correlated with subjective spherical equivalent and other biometric measurements obtained by Orbscan (i.e., anterior chamber depth, axial length, corneal diameter). RESULTS: Reproducibility of the angle measurement was significantly better with the plane mode than with the polynomial mode (5.4%+/-4.7 versus 7.2%+/-6.2; p<0.001). Reproducibility significantly varied with localization (p<0.001). Significant differences were found between reconstruction modes (49.3 degrees +/-4.6 degrees for plane mode versus 42.8 degrees +/-6.7 degrees for the polynomial mode; p<0.001) and according to localization (p=0.02). Correlation with the other biometric measurements was higher for the plane mode than for the polynomial mode. Angle measurement with the plane mode showed significant correlation with subjective spherical equivalent (r(s)=-0.59; p<0.001), the anterior chamber depth measurement (r(s)=-0.74; p<0.001), the axial length measurement (r(s)=-0.34; p<0.002), and the corneal diameter measurement (r(s)=-0.34; p<0.002). CONCLUSION: The iridocorneal angle measure obtained with the plane mode showed high reproducibility and it significantly correlated with clinical parameters. It appears to be useful for clinical application.

Adolescent↗
PubMed2002

[Amniotic membrane transplantation in severe corneal epithelial diseases. Preliminary results].

PURPOSE: To evaluate amniotic membrane transplantation (AMT) in severe corneal epithelial diseases. METHODS: Amniotic membrane transplantation was performed in 14 eyes of 14 patients from four groups: A, five severe ocular burns; B, four cases of cicatricial keratoconjunctivitis; C, three persistent epithelial defects after penetrating keratoplasty; D, two cases of pseudophakic bullous keratopathy. Five patients underwent AMT alone; two patients underwent AMT combined with limbal transplantation; the other three patients had limbal transplantation performed before AMT. Eight patients required combined penetrating keratoplasty. Patients with corneal stable reepithelialization, no corneal neovascularization, and no recurrence of the initial pathology were considered successful. RESULTS: The mean follow-up was 7+/-3 months. All but three patients underwent corneal reepithelialization within 6 weeks of AMT, with a mean healing time of 31+/-23 days. The success rate was 75% at 6 months (Kaplan-Meier method). Three of four procedures in group B failed. In eight patients, visual acuity improved, in one it worsened, and in the last five patients it remained unchanged. Visual acuity increased by an average of 7+/-9 lines. CONCLUSION: AMT is a useful technique for ocular surface reconstruction, especially in association with limbal transplantation. It could also improve the prognosis of penetrating keratoplasty in patients with severe corneal conditions.

Adolescent↗
PubMed2002

[Fungal keratitis at the Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts: retrospective study of 19 cases].

PURPOSE: To report the spectrum of fungal keratitis at the Centre Hospitalier National d'Ophtalmologie XV-XX, Paris. METHODS: We reviewed 19 cases of fungal keratitis from January 1993 to January 2001. We evaluated the different risk factors, fungal identification, topical and systemic antifungal therapy, surgical treatment and outcome. RESULTS: Nineteen patients were included, 7 women and 12 men, with visual acuity ranging from 9/10 to no perception of light. The mean age was 56.2 years. Patients were hospitalized for an average stay of 16.3 days and all received a diagnostic and therapeutic scraping and 16 received a local antifungal treatment. The most common risk factors were topical steroid treatment (42.1%), corneal graft (31.6%), trauma or foreign body (31.6%). The mean delay between the first signs and fungal keratitis diagnosis was 14 days. Yeast as Candida parapsilosis and albicans were the most frequently isolated fungi (58%), followed by Aspergillus sp. (21%) and Fusarium sp. (21%). The most commonly used topical treatment was amphotericin B, and itraconazole was used as systemic treatment. Five patients had evisceration, 6 had penetrating keratoplasty and 5 retained leukoma. CONCLUSION: Candida was the most frequently isolated fungi and topical steroid treatment the main risk factor. The prognosis is relatively poor (26% of lost vision) because of a delay in diagnosis and other previous ocular pathology or surgery.

Adolescent↗
PubMed2002

[Clinical management and prognosis in Acanthamoeba keratitis: a retrospective study of 25 cases].

PURPOSE: To assess risk factors, clinical characteristics, diagnosis and outcome in patients with Acanthamoeba keratitis. METHODS: We reviewed 23 patients (25 eyes) treated for Acanthamoeba keratitis in the XV-XX Hospital between November 1994 and October 2000. Acanthamoeba were found either in corneal scrapings and/or contact lenses and/or storage solutions. RESULTS: A predisposing factor was found in 22/23 patients: most of them (20/22) were contact lens (CL) wearers, two patients had a recent history of corneal trauma, and 15/23 patients had been treated for presumed herpetic keratitis before examination in our hospital. The average delay between first symptoms and diagnosis was 2 months. All patients were treated with two or three topical antiparasitic eye drops for 2 to 6 months. Five patients received systemic treatment (ketoconazole or itraconazole). Nine eyes received surgical treatment: penetrating keratoplasty in eight cases, conjunctival flap in one case, enucleation in one case. Visual outcome was poor in ten eyes (less than 20/60) because of delayed diagnosis. CONCLUSION: Acanthamoeba keratitis is a serious vision-threatening disease. Early diagnosis and treatment are essential for improving visual outcome. Methods such as confocal microscopy and Acanthamoeba-PCR, allowing earlier diagnosis and treatment, will improve the management of Acanthamoeba keratitis.

Acanthamoeba Keratitis↗
PubMed2001

Recombinant congenic strains derived from A/J and C57BL/6J: a tool for genetic dissection of complex traits.

Complex genetic traits can be dissected in mice, using well-defined sets of recombinant inbred strains, congenic strains, and recombinant congenic strains (RCS). We report the creation of a series of 37 independent RCS derived from the commonly used inbred strains of laboratory mouse A/J (A) and C57BL/6J (B6). These RCS were derived by systematic inbreeding of independent pairs of animals from a (F1 x A) x A and a (F1 x B) x B double backcross (N3), to create AcB and BcA strains, respectively. Fifteen AcB strains and 22 BcA strains at between 18 and 30 generations of inbreeding have been generated, are healthy, and show stable breeding performance. These strains have been genotyped for a total of 625 informative microsatellite DNA markers covering the entire genome, with an average spacing of 2.6 cM. Haplotype analyses indicate that on average, AcB and BcA strains contain 13.25% of the donor genome, a value close to the 12.5% expected from the breeding scheme used in their creation. In the AcB set, approximately 79% of the B6 genome has been transferred in independent strains, while in the BcA set approximately 84% of the A genome is represented on the B6 background. This represents an excellent coverage of congenic segments from both parental genomes in the two sets of strains, which can now be used to map simple and complex traits in a genome-wide fashion. As an example of the power of AcB/BcA strains as a mapping tool, the 37 strains were typed for susceptibility to infection with Legionella pneumophila, a monogenic trait controlled by the Lgn1 locus on Chromosome 13. Analysis of the strain distribution pattern of L. pneumophila susceptibility allowed direct mapping of Lgn1 to a 3-cM interval. The AcB/BcA set should prove a useful tool with which to investigate the complex genetic basis of known interstrain differences between A and B6 for many important diseases.

Animals↗
PubMed2001

Outcome of Corneal transplantation rejection.

PURPOSE: To identify predictive factors for reversibility of corneal graft rejection. METHODS: The study design was a prospective cohort study. Among 440 consecutive penetrating keratoplasties performed at our institution, 79 grafts from 79 patients who developed signs of transplant rejection were included. Donor, recipient, surgical, and rejection variables were studied, at both univariate and multivariate levels. RESULTS: The rate of reversibility was 51% (40/79). The average postoperative time of rejection was 10.5 +/- 9.3 months, and the average time of visual acuity recovery in patients with reversible rejection was 2.4 +/- 2.3 months. In logistic regression, only two variables significantly influenced the rate of reversibility. The preoperative diagnosis (p = 0.04) influenced the rate of rejection reversibility; patients with bullous keratopathy or regraft were more likely to experience irreversible rejection than patients with keratoconus or Fuchs' dystrophy. The average graft thickness at the time of rejection diagnosis was 774 +/- 129 microm in patients with irreversible rejection and 681 +/- 118 microm in patients with reversible rejection (p = 0.001). CONCLUSION: Rejection was reversible in half of the cases. Rejection was more likely to be irreversible in patients with marked increase in graft thickness and in patients transplanted for bullous keratopathy or graft failure. Donor variables did not influence rejection reversibility.

Adolescent↗
PubMed2001

Screening human donor corneas during organ culture for the presence of guttae.

AIMS: To detect the presence of guttae by means of light microscopy during organ culture and to evaluate the influence of the presence of guttae in the donor tissue on transplantation outcome. METHODS: Donor corneas were investigated for the presence of guttae by means of light microscopy at the end of organ culture. Recipient corneal buttons from patients with severe Fuchs' dystrophy and donor corneas with advanced guttae were first studied by light microscopy and subsequently by transmission electron microscopy. Lastly, 168 consecutive donor corneas were evaluated for the presence of guttae and issued for transplantation. RESULTS: Corneal specimens with Fuchs' dystrophy displayed numerous round highly reflecting guttae at the level of the corneal endothelium. Donor corneas with advanced guttae showed less numerous guttae. Among 168 organ cultured donor corneas issued for transplantation, low density guttae were found in 43 (25.6%) corneas. The endothelial cell density and figure coefficient were significantly lower and organ culture time was significantly higher in the cornea guttata group than in the control group. The presence of grouped guttae significantly decreased the adjusted graft survival. The incidence of postoperative stage 3 cornea guttata was significantly higher when grouped guttae were found (5/6) than when no guttae or scattered guttae were found (8/101). CONCLUSION: Cornea guttata can be detected during organ culture by means of light microscopy. It is associated with a decrease in endothelial cell figure coefficient and cell density. The presence of grouped guttae is associated with poorer graft survival and more frequent stage 3 cornea guttata in the graft after transplantation.

Adolescent↗