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J F Rouland

Publications and source records attributed to J F Rouland.

At least 19 recordsLinked to original sources
PubMed2005

[Vitreous hemorrhage in a neonate with galactosemia. A case report].

Galactosemia is an inherited metabolic disorder due to a defect in one of the three enzymes required to fully metabolize the galactose in glucose: the galactose 1-phosphate uridyltransferase. Because this enzyme is present in the normal foetal liver since the tenth week of gestation, its defect cause congenital abnormality due to galactose accumulation, when the mother had taken milk during the pregnancy. It is mainly a liver pathology whereas the foetal cataract is rare. This latter is usually considered as the sole ophthalmic consequence of this disorder but exceptional ocular haemorrhages have also been described. We report the case of a neonate with galactosemia free from foetal cataract but presenting an unilateral vitreous haemorrhage. Retinal anomalies seen after vitrectomy are probably the source of the vitreous blood favoured by the coagulopathy associated with the neonatal disease. The causes of infant vitreous haemorrhages are often debated and their complications, especially severe amblyopia, require vitrectomy within the month following their discovery. In galactosemia, vitreous haemorrhage can be prevented by an early diagnosis and an appropriate treatment of the liver pathology.

Galactosemias↗
PubMed2003

Naturalistic, prospective study of glaucoma and ocular hypertension treatment in France: strategies, clinical outcomes, and costs at 1 year.

PURPOSE: To prospectively observe second-line treatment strategies, their clinical outcomes, and treatment costs in patients with glaucoma or ocular hypertension (OH) in France. METHODS: Patients were recruited between 1998 and 2000 in 37 centers and were followed for up to 2 years. Outcomes were numbers of and reasons for treatment changes, changes in clinical parameters (intraocular pressure [IOP] levels, visual field defects, and optic nerve excavation), and direct medical costs associated with glaucoma management in patients receiving monotherapy or combination therapy. This article reports results of an interim analysis of 1-year follow-up data for patients having at least two contacts with a study ophthalmologist. RESULTS: Data were analyzed for 283 patients and 549 treated eyes. Ocular hypotensive monotherapy was used as first-line therapy in 92.0% of eyes. Second-line treatment was initiated an average of 3.4 +/- 0.5 years after diagnosis, primarily due to insufficient IOP control (62.8%). Mean IOP reductions after 1 year of second-line therapy were 3.0 mmHg in eyes treated with latanoprost monotherapy versus 2. 1 mmHg in those receiving beta-blocker monotherapy (p = 0.02) and 5.4 mmHg in eyes treated with the latanoprost + timolol combination versus 4.1 mmHg in those receiving combination therapies that did not include latanoprost (p = 0.01). Although second-line treatment with latanoprost was more costly than treatment with beta blockers, the average daily cost for latanoprost monotherapy was similar to that for patients who failed beta-blocker monotherapy, and latanoprost + timolol was less costly than therapeutic combinations without latanoprost. CONCLUSIONS: Insufficient IOP control is the main reason for changing first-line treatment in patients with glaucoma or OH. After 1 year, second-line treatment with latanoprost, as monotherapy or combined with timolol, provides superior IOP control at an acceptable cost.

Aged↗
PubMed2003

Changes in medical and surgical treatments of glaucoma between 1997 and 2000 in France.

PURPOSE: To analyze quantitative changes in glaucoma treatment strategies between 1997 and 2000 in France. METHODS: Numbers of ab externo trabeculectomies and other glaucoma surgeries were extracted from the national database of the French Diagnosis Related Group system, which includes data for both public and private hospitals. Mean lengths of stay and hospital costs were estimated using national cost scales published by the French Ministry of Health. Numbers of patients treated per year with latanoprost, brimonidine, or the fixed combination of dorzolamide + timolol were estimated from drug unit sales using defined daily doses for each drug. RESULTS: Between 1997 and 2000, the number of patients treated with a glaucoma drug increased from 410,000 to 734,000 patients per year. This increase was associated with the introduction of three new glaucoma drugs: 245,000 patients received latanoprost (71.0%), brimonidine (28.8%), or the fixed combination of dorzolamide + timolol (0.2%). During the same period, the surgery rate in patients receiving medical treatment declined by 47%, from 5.9% to 3.1% . The total number of glaucoma interventions declined by 4.6% (-12% in public hospitals and 0% in private hospitals). This relative stability resulted mostly from a shift from trabeculectomies to other procedures, mainly to new filtering procedures in private hospitals. CONCLUSIONS: Between 1997 and 2000, new glaucoma drugs, primarily latanoprost and brimonidine, improved intraocular pressure control and delayed surgery, reducing the glaucoma procedure rate in patients receiving glaucoma-related medical treatment by 47%.

Antihypertensive Agents↗
PubMed2002

The efficacy and safety of unfixed and fixed combinations of latanoprost and other antiglaucoma medications.

Adjunctive therapy for the management of glaucoma is commonly used. Unfixed combinations of the prostaglandin analog latanoprost and other glaucoma medications have been demonstrated to effectively lower intraocular pressure (IOP). The range of reported additional reductions in IOP compared to a monotherapy baseline are as follows: latanoprost-timolol (13-37%), latanoprost-pilocarpine 2% (7-14%), latanoprost and carbonic anhydrase inhibitors (15-24.1%), and latanoprost and dipivefrin (15-28%). There is a fixed combination of latanoprost (0.005%) and timolol (0.5%) that has been investigated in Phase III trials in Europe and the United States. In these trials, it was noted that the efficacy of the fixed combination was superior to either of the monotherapy components. After 12 months of follow-up of patients on fixed combination, there was no evidence of long-term drift. The new formulation appears to be safe and does not demonstrate any more side effects than either of the components. The convenience of a fixed combination may enhance patient compliance. Unfixed combination therapy with latanoprost and other antiglaucoma medications and the fixed combination formulation of latanoprost and timolol provide an effective and safe option for lowering IOP in glaucoma patients.

Adrenergic beta-Antagonists↗
PubMed2002

[Creating a specific quality-of-life questionnaire in patients with glaucoma: item generation].

The methods for developing Health-Related Quality-of-Life (HRQoL) measures and their application in medical research have demonstrated their utility in various chronic, progressive, or life-threatening diseases. The efforts made to allow the patient's perspective to be included in the methodological framework of evidence-based medicine have been successful. The assumption of a strong relationship between clinical status and daily life is certainly valid in ophthalmology. However, there is a lack of specific HRQoL measures dedicated to ophthalmic diseases. Our work aimed at creating the first Glaucoma-specific Quality of Life scale - the Glau-QoL questionnaire - to provide researchers and physicians with a comprehensive, practical, and validated tool. This article describes the first stage of the process, which consisted in generating items and formatting them in order to create a questionnaire that exhaustively covers the relevant concepts. The whole process was conducted by an expert committee including clinicians and methodologists. The standard recommendations in the development of a HRQoL questionnaire were followed: we first identified existing tools and performed a preliminary collection of concepts from the published literature; we then designed an interview guide with the help of clinicians; a trained psychologist interviewed 22 patients at various disease severity stages (from isolated hypertonic to severely impaired); the interviews were tape-recorded and scripted; general domains and related detailed concepts were identified from the script; they were then analyzed and organized; the format of the questionnaire was set up; and questions were derived from the patient's verbatim to capture the identified detailed concepts. The test questionnaire was applied to seven patients for cognitive debriefing. We finally amended the test questionnaire and designed the pilot questionnaire according to the patients' tests and the clinician's review. The test questionnaire was well accepted by the patients, despite a completion duration ranging from 14 to 35 minutes. The pilot questionnaire contained 151 items, grouped into 5 sections: (1) vision problems, physicians, and daily treatment (49 items); (2) activities of daily living (37 items); (3) self-expression (37 items); (4) vision problems and mood (14 items); and (5) other questions (14 items). The next step of our work will be the item reduction process and the psychometric validation of the Glau-QoL questionnaire.

Activities of Daily Living↗
PubMed2001

Additive IOP-reducing effect of latanoprost in patients insufficiently controlled on timolol.

PURPOSE: To evaluate the effect on intraocular pressure (IOP) of switching from timolol to latanoprost or adding latanoprost to timolol in patients with open angle glaucoma or ocular hypertension where IOP is not adequately controlled with timolol. METHODS: This was a 6-week, double-masked, randomised multi-centre study. 53 patients with primary open angle glaucoma, capsular glaucoma, or ocular hypertension with an IOP of at least 21 mmHg on current therapy were recruited. After a run-in period of at least 2 weeks on timolol, 5 mg/ml twice daily, patients were randomised to one of three groups. One group continued on timolol, one switched from timolol to latanoprost, 50 microg/ml once daily, and a third group received latanoprost in addition to timolol. The efficacy was evaluated by comparing IOP at 9 AM at baseline and after 6 weeks of treatment. RESULTS: IOP at baseline and after 6 weeks of treatment (mean +/- SEM) were 24.2 +/- 0.9 and 23.8 +/- 1.0 mmHg (n = 16) for patients continuing on timolol, 26.3 +/- 1.2 and 19.6 +/- 1.1 mmHg (n = 17) for patients switching to latanoprost, and 23.2 +/- 1.0 and 17.5 +/- 0.8 mmHg (n = 17) for patients with combined treatment. Adding latanoprost to timolol reduced IOP with 5.9 +/- 0.9 mmHg (p < 0.001) and switching from timolol to latanoprost reduced IOP with 5.0 +/- 0.9 mmHg (p < 0.001), which caused in each group a significant IOP reduction of about 25%. CONCLUSIONS: The effect of latanoprost was additive to that of timolol, and a good effect on IOP reduction was also achieved by switching from timolol to latanoprost, suggesting that a switch in many patients is an effective alternative to combination treatment.

Adult↗
PubMed2001

[An observational, retrospective two-year cost study in primary open-angle glaucoma and ocular hypertension in newly diagnosed patients].

PURPOSE: To investigate the different treatment strategies in France and the direct costs for patients with newly diagnosed primary open-angle glaucoma or ocular hypertension who have started treatment with beta-blockers, and to estimate the total direct cost for two years of treat. MATERIAL: and methods: We analyzed 225 medical charts retrospective in eleven academically and office-based centers in France over the first two years after diagnosis. Standard costs for each resource in current medical practice were determined from the French Social Security perspective. RESULTS: The vast majority of patients (90%) had a diagnosis of primary, open-angle glaucoma or ocular hypertension in both eyes. In 60% of the patients we found a moderate or severe defect in their visual field or optic nerve. Intraocular pressure before treatment was 23.9+4.7mmHg and 17.5+4.2mmHg after two years of treatment. Over the first two years, 25% of visits led to a change in therapy (medical or surgical), involving 64% of the patients. Two-thirds of the changes occurred during the first year of treatment and in around 80% of cases for low intraocular pressure at check-up. Laser surgery or surgical intervention was performed in 25% of the patients. Total direct costs for two years were 5698F.F. The intraocular pressure before treatment was positively correlated (p<0.01) with treatment costs, while the initial intraocular pressure-lowering effects of treatment were negatively correlated with two-year costs. CONCLUSION: After two years of treatment, the mean intraocular pressure decreased from 24 to 17.5mmHg. The higher the basal intraocular pressures is, the more intensive the treatment and the higher the costs. The more efficient the treatment to decrease baseline intraocular pressure is, the earlier the costs will be reduced.

Aged↗
PubMed2001

[Gyrate atrophy of late disclosure].

Gyrate atrophy of the choroid and retina is a chorioretinal degeneration caused by a deficiency of ornithine aminotransferase. We report the case of a 29-year-old woman who showed an advanced stage of gyrate atrophy of the choroid and retina fortuitously discovered. Examination of the patient provided an opportunity to describe pathophysiology, knowledge on the ornithine aminotransferase gene, and finally the therapeutics used in this disease.

Adult↗
PubMed2000

High prevalence of sleep-disordered breathing in patients with primary open-angle glaucoma.

PURPOSE: Elevated intraocular pressure and systemic hemodynamic changes are main risk factors in primary open-angle glaucoma (POAG). Sleep-disordered breathing (SDB) characterized by snoring, excessive daytime sleepiness and insomnia is accompanied by large swings in blood pressure and repetitive hypoxic periods during sleep. The aim of this study was to evaluate whether there is any relationship between SDB and POAG. METHODS: Consecutively, 212 outpatients with POAG and 218 outpatients without POAG were recruited. Both eyes were examined. An interviewer-administered semi-structured questionnaire was used to collect SDB-related symptoms. RESULTS: After controlling for age, relative to control group, POAG patients showed a high prevalence of snoring (47.6%, p=0.04), snoring plus, excessive daytime sleepiness (27.3%, p=0.01) and snoring plus, excessive daytime sleepiness, plus insomnia (14.6%, p=0.01). CONCLUSION: We found a high prevalence of SDB in patients with POAG. Chronic hemodynamic changes and recurrent severe hypoxia resulting from SDB may contribute to anoxic optic nerve damage, implicated in glaucoma.

Aged↗
PubMed2000

Comparison of the intraocular pressure lowering effect of latanoprost and a fixed combination of timolol-pilocarpine eye drops in patients insufficiently controlled with beta adrenergic antagonists. French Latanoprost Study Group, and the Swedish Latanoprost Study Group.

AIMS: To compare the effect on intraocular pressure (IOP) of latanoprost monotherapy and timolol-pilocarpine in patients with glaucoma or ocular hypertension with inadequately controlled IOP on topical beta adrenergic antagonists. METHODS: This was a multicentre, randomised, observer masked, 6 week study performed in France and Sweden. 23 centres enrolled 237 patients with glaucoma or ocular hypertension and an IOP of at least 22 mm Hg on treatment with topical beta adrenergic antagonists, alone or in combination. After a 21 day run in period on timolol 0.5% twice daily, patients were randomised either to latanoprost 0.005% once daily or to a fixed combination of timolol-pilocarpine twice daily. Changes in mean diurnal IOP from the baseline to the 6 week visit were determined with an analysis of covariance. RESULTS: Mean diurnal IOP was statistically significantly decreased from baseline in both groups (p<0.001). Switching to latanoprost treatment reduced mean diurnal IOP by 5.4 (SEM 0.3) mm Hg (ANCOVA -22%) and switching to timolol-pilocarpine treatment reduced mean diurnal IOP by 4.9 (0.4) mm Hg (-20%). Blurred vision, decreased visual acuity, decreased twilight vision, and headache were statistically significantly more frequent in the timolol-pilocarpine group. CONCLUSIONS: Latanoprost monotherapy was at least as effective as fixed combination timolol-pilocarpine twice daily treatment in reducing mean diurnal IOP in patients not adequately controlled on topical beta adrenergic antagonists. Latanoprost was better tolerated than timolol-pilocarpine regarding side effects. These results indicate that a switch to latanoprost monotherapy can be attempted before combination therapy is initiated.

Adult↗
PubMed2000

[Relevance of quality of life and treatment compliance measurement in patients with chronic open-angle glaucoma].

Chronic glaucoma is a severe disease that can induce blindness.Early diagnosis and symptomatic treatment reduce the risk of blindness. Treatment that will be started before the onset of clinical signs and will remain lifelong thereafter is troublesome, and therapeutic compliance is usually poor. Thus, quality of life (QOL) measurement in patients with chronic glaucoma has a particular purpose: to measure patients' perception of the disease and treatment in order to maintain good treatment compliance to ensure therapeutic management efficacy and to preserve visual function. No glaucoma-specific instrument is available in the medical and QOL literature. Various generic(SF-36, SF-20 and SIP) and specific(VAQ, VF-14, NEI-VFQ) QOL questionnaires,one glaucoma-specific symptomatic scale (GSS),and one treatment preference scale (COMTol) have been used to measure QOL in glaucoma patients. These instruments do not sufficiently measure the psychosocial dimension of the disease and the QOL impact of treatment. An instrument able to measure all dimensions needs to be developed in order to help ophthalmologists in the therapeutic management of their patients and to measure QOLin patients in the successive stages of the disease.

Attitude to Health↗
PubMed1999

Survival after malignant tumors of the orbit and periorbit treated by exenteration.

PURPOSE: In order to further assess the survival value of orbital exenteration in malignant orbital and periorbital tumors. METHODS: The charts of 44 patients exenterated for a neoplasm of the orbit or periorbit were reviewed in a retrospective study. RESULTS: The overall 4-year survival was 45%. 26 patients had free margins on histological examination and 24 patients had developed local recurrence or metastasis. Local recurrence or metastasis were significantly more common in the group with transected margins than in the group with free-margins (p= 0.01). Survival between the group of patients with local recurrence or metastasis and the group without local recurrence or metastasis showed statistically significant difference (p=0.0025). In contrast, survival between the group of patients with free margins and the group with transected margins did not show statistically significant difference (p=0.13). CONCLUSION: Surgical free margins section is a key element in successful cancer surgery but seems not the only prognosis variable.

Adolescent↗
PubMed1999

A comparison of the intraocular pressure-lowering effect of 0.5% timolol maleate and the docosanoid derivative of a PGF2 alpha metabolite, 0.12% unoprostone, in subjects with chronic open-angle glaucoma or ocular hypertension.

The efficacy of 0.5% timolol was compared with that of the prostaglandin derivative unoprostone in maintaining control of intraocular pressure (IOP) in subjects with chronic open angle glaucoma (COAG) or ocular hypertension (OH) already responding satisfactorily to beta-blocker monotherapy. In a two-centre, double-masked, randomised parallel group study, 40 subjects were placed on 0.5% timolol eyedrops twice daily for two weeks. They were then randomised either to continue with 0.5% timolol or to switch to 0.12% unoprostone, applied twice daily for six weeks. IOP was measured at two-weekly intervals. The status of the conjunctiva, iris, cornea and anterior chamber was kept under observation. Ocular safety was monitored by measurements of visual acuity, and any systemic adverse events were recorded. After six weeks' treatment, there were no statistically significant differences in mean change from baseline IOP within or between treatment groups. For the subjects treated with unoprostone, mean IOP increased by 0.69 mm Hg (p = 0.368) while that of the timolol-treated subjects fell by 0.47 mm Hg (p = 0.287). The difference in mean IOP between groups was 1.16 mm Hg (p = 0.211, 95% confidence interval [CI] -0.69 to 3.02). The most common complaint was a mild and transient burning sensation on instillation which occurred more frequently in the unoprostone group. In conclusion, an aqueous solution of 0.12% unoprostone isopropyl, applied topically to the eye twice daily for six weeks, was as effective as 0.5% timolol in maintaining control of IOP in subjects with chronic open angle glaucoma or ocular hypertension. Both treatments were safe and well tolerated.

Adrenergic beta-Antagonists↗
PubMed1998

Founder effect in GLC1A-linked familial open-angle glaucoma in Northern France.

Open-angle glaucoma (POAG) is a highly prevalent cause of visual impairment. Six families grouping 71 living patients affected with juvenile-onset and middle-age POAG (age at diagnosis ranging from 10 to 65 years) were linked to the GLC1A locus. All patients carried a mutation of an evolutionarily conserved asparagine residue to a lysine at position 480 (N480K) in the olfactomedin-homology domain, which is encoded by the third exon of the GLC1A gene. The N480K mutation was also identified in 14 unaffected carriers who are at high risk of developing POAG. Although four of the families had ancestors identified in Northern France, the pedigrees could not be interconnected by genealogical investigation. However, haplotype analysis indicated that all the carriers had inherited the N480K mutation from the same founder. Screening of a selected set of 67 POAG patients who originated from Northern France and underwent trabeculectomy before the age of 50, detected one patient with the N480K mutation associated with the same disease haplotype already characterized in the 6 families. This group of 72 POAG patients is the largest one having a GLC1A mutation in common and provides a unique tool to investigate the factors influencing the variable expressivity of the GLC1A gene.

Adolescent↗
PubMed1998

Virtual reality versus conventional training in retinal photocoagulation: a first clinical assessment.

Virtual reality can provide a new method for apprenticeship in surgery. We have developed a training simulator for retinal photocoagulation. This paper describes a comparison between this new training tool and the conventional teaching method. Residents were divided into two groups, each group being trained exclusively with one of the methods. A final evaluation was made by a single expert, who did not know which training mode the residents had undergone. The results show that this new training mode is at least as efficient as the current one and may reduce training duration. While experts remain in control of the contents of training and assessment of skill, this study outlines new prospects for apprenticeship and evaluation in the field of medicosurgical techniques. In addition, this preliminary study emphasizes the difficulties in introducing a new modality in a traditional teaching environment.

Humans↗