Expériences visuelles au cours de la chirurgie de la cataracte sous anesthésie péribulbaire

But. Décrire les expériences visuelles des patients au cours de la chirurgie de la cataracte sous anesthésie péribulbaire. Patients et méthodes. Nous avons mené une étude transversale pendant une période d'un mois au CHU-IOTA (Bamako). Étaient inclus les adultes opérés de la cataracte sous anesthésie péribulbaire sans sédation. Les patients étaient interrogés 1 à 4 heures après l'intervention sur les sensations visuelles de l'œil opéré, durant la chirurgie. Résultats. Deux cent sept (207) patients (105 hommes et 102 femmes) ont été retenus. Leur âge moyen était de 62,94 ans ± 12,5. L'acuité visuelle préopératoire des patients était comprise entre 1/10 et la perception lumineuse. Cent cinquante-huit (76,3%) patients ont rapporté des phénomènes visuels observés pendant l'intervention. Il s'agissait de la lumière (rapportée par 76,3% de patients), des couleurs (31,9%), des instruments (22,7%), des doigts du chirurgien (25,1%), de l'eau (27,1%) et des mouvements vagues (19,8%). Parmi eux, 38% étaient effrayés par ces sensations visuelles. Conclusion. Plus de trois-quarts de patients ont des expériences visuelles au cours de la chirurgie de la cataracte sous anesthésie péribulbaire. Certains sont effrayés par ces phénomènes visuels. Il est important de faire un counseling préopératoire approprié afin de réduire le stress des patients

La phacoalternative manuelle sans suture dans la chirurgie de masse de la cataracte de l'adulte à Libreville

Introduction. La phacoalternative manuelle sans suture (PhacoA) est une technique chirurgicale révolutionnaire adaptée à l'Afrique car sollicitant un minimum de matériel opératoire avec un bon résultat fonctionnel. Le but de cette étude était d'évaluer les résultats fonctionnels de la phacoA en chirurgie de masse de la cataracte de l'adulte. Patients et méthodes. Il s'est agi d'une étude descriptive et analytique qui s'est déroulée en mars et d'avril 2017 au Centre Hospitalo-universitaire d'Angondjé (CHUA). Tous les patients adultes présentant une cataracte ont été inclus. L'acuité visuelle de loin a été évaluée à l'aide de l'échelle de Monoyer. Une biomicroscopie a été réalisée à la recherche d'une cataracte et d'une pathologie oculaire associée. La pression intraoculaire a été mesurée chez tous les patients. La phacoA a été réalisée chez tous les patients. Les variables étudiées étaient l'âge, le sexe, l'acuité visuelle avant et après chirurgie, les complications per et post opératoires. Les données ont été saisies avec le logiciel Microsoft Access 2010 et analysées avec Microsoft Excel 2010. Résultats. L'âge moyen était de 67,3 ans ± 10,4. Les hommes représentaient 51,5% de la population. L'acuité visuelle avant la chirurgie était limitée à la perception lumineuse dans 32% des cas et après la chirurgie supérieure ou égale à 3/10 dans 75,4 % des cas. Les complications per et post-opératoires ont été décrites. Conclusion. La phacoalternative reste la technique de choix dans la chirurgie de masse de la cataracte de l'adulte

Ectropion and Entropion in Sub-Saharan Africa: How do we Differ?

Aims: To study the etiopathophysiology of ectropion and entropion in a sub-Saharan tertiary eye care center and examine how it differs from reports elsewhere. Methods and Materials: This was a retrospective audit of all consecutive patients who presented with ectropion or entropion to the oculoplastics clinic of a tertiary eye care unit. We reviewed the medical records of all such patients and data extracted include age; gender; etiopathology; and diagnosis. The primary oculoplastic disease was used in classifying the patients. The study period covered January 2008-June 2012. Results: A total of 53 patients were identified constituting 37.3 of all eyelid diseases. Thirty-three (62.3) were males. Forty-eight (90.6) had ectropion; 43(89.6) of which were cicatricial ectropion. Five (9.4) had entropion. The median age group affected was 30-39 years (26.4). There were no cases of congenital ectropion or entropion. The leading etiological factor was trauma in 36 cases (67.9); which was mostly due to road traffic accidents (50.9). Conclusions: This study highlights a difference in etiopathophysiology of ectropion and entropion in a sub-Saharan region when compared to reported data from developed countries. In Nigeria; ectropion (which is often cicatricial) is usually secondary to trauma whereas senile involution is the common cause in many developed countries. This finding has implications in appropriate planning and skill acquisition for surgical correction in this group of patients

Teaching Corner: Regional Anaesthesia for Ophthalmic Surgery

Performing safe and effective regional anaesthesia for ophthalmic surgery is an important skill for anaesthetic and ophthalmologic practitioners. Akinetic sharp-needle blocks are generally safe but rare; sight and life threatening complications occur. Sub-Tenon's block using a blunt canula provides akinesa and is a safer alternative but serious complications have been reported. This review provides an introduction to the relevant anatomy; local anaesthetic drugs and commonly used techniques and a practical guide to their safe performance

Trichiasis Recurrence in North Ethiopia: a one Year Prospective Study of Trachomatous Trichiasis Surgery done by Integrated Eye Care Workers

Background: Blindness due to trachomatous trichiasis can be prevented by simple eyelid surgery that can be performed by trained nurses. Objective: To evaluate the post- operative outcome of posterior tarsal rotation done by integrated eye care workers (IECWs) at the twelfth postoperative month. Methods: A prospective study to evaluate trichiasis surgery for recurrence was conducted in Yilmana Densa District. Trained IECWs did transverse tarsotomy with lid margin rotation for 455 patients with trichiasis following the standard procedure. Post-operative follow-up evaluation was done at the 12th month by IECWs who neither took part in the operation nor knew the specific surgeons for the corresponding patients. Results: Out of 695 a total of 560 operated eyelids were available for follow-up just at the 12th month. In terms of persons; 79.3(361/455) patients came for follow-up evaluation. The recurrence rate among the operated eyelids was found to be 16.6. There was an increase in likelihood of having recurrence with increasing age of patients (X2=5.6; P=0.02). We also found a statistically significant difference in rates of recurrence among patients operated by different surgeons(X2 =12.8; P=0.005). Conclusion: Trichiasis recurrence following surgery done by non-ophthalmologists is low indica- ting the possibility of avoiding preventable blindness due to trachoma through the training of integrated eye care workers. Moreover; monitoring mechanism appeared essential to track the performance of IECWs

Epidemiology of Hospitalized Ocular Injuries in the Upper East Region of Ghana

Aim of Study: The Upper East is the poorest and most rural region in Ghana and ocular injuries are a major public health problem. This study aims at providing epidemio- logic data on the burden of this problem in order to facilitate the provision of integrated eye care and safety strategies for the prevention of such injuries in the region. Design: A retrospective case series. Methods: Computerized records of all eye injuries admitted to the clinic between January and December 2004 were retrieved and analyzed using the Epi-Info software. Injuries were classified using the Birmingham Eye Trauma Terminology while Snellen visual acuities were classified/ banded using the WHO categories of visual impairments. Results: Ninety six eyes of 96 patients were admitted over the study period. Seventy five percent of the patients were males and 82.3 below the age of 30 years. Half of the patients had to travel beyond 100 km to get ophthalmic assistance. Only one third of the cases reported within 24 hours while 21 reported after one week of their injuries. These delayed periods of reporting showed no statistically significant relationship with the distances travelled to the hospital (p=0.76; chi2 test); nor the eventual visual outcome achieved following treatment. Open-globe injuries were by far the most common (60/96) and were 4.7 times more likely (Chi squared test) to produce poor visual outcome (p=0.02 CL 1.75-12.63). Conclusion: Current eye care strategies do not adequately address the issue of eye injuries in the region. There is the need to provide integrated approach by incorporating primary eye care strategies into the existing primary health care system