[Should patients with age-related macular degeneration have cataract surgery?]. / Faut-il opérer de la cataracte les patients porteurs d'une dégénérescence maculaire liée à l'âge?

PURPOSE: To study the progression of visual acuity (VA) and retinal abnormalities in patients with age-related macular degeneration (AMD) after cataract surgery. METHODS: Forty eyes of 25 patients with AMD who had had cataract surgery were included in the study. They were divided up into two groups according to AMD stage: the first group with drusen and retinal pigmented epithelium abnormalities and the second in the severe stages of age-related macular degeneration with atrophy and neovascularization. RESULTS: In the first group (15 eyes), we found an improvement in VA in 93.3% of the eyes. New manifestations of neovascularization appeared in only one eye (6.7%) 1 year after surgery. In the second group (25 eyes), we found atrophy in 80% of the eyes and neovascularization in 20% of the eyes before surgery. There was an improvement in VA after cataract surgery in 68% of the eyes, and in three eyes (17%) VA worsened. CONCLUSION: In our study, patients with AMD improved VA and quality of life after cataract surgery. The same results of VA improvement after surgery can be found in the literature. However, no conclusions can be made concerning the progression of fundus lesions on a short term, though it seems that cataract surgery may accelerate the progression of AMD lesions 5 years after surgery.

[Retinal arteritis in a case of sarcoidosis. A case report]. / Artérite rétinienne dans un cas de sarcoïdose.

Retinal vasculitis is a common finding and occurs in 10% - 83% of patients with sarcoidosis. In most cases, there are bilateral, peripheral and nonischemic periphlebitis. In contrast, periarterial involvement is rarely observed. We report a case of retinal vasculitis associated with sarcoidosis and its differential diagnosis. Sarcoidosis should not be excluded in case of periarteritis.

[Cataract in uveitis patients: extracapsular and intraocular posterior implantation results. A retrospective study of 14 eyes]. / Cataracte et uvéite: résultats après implantation en chambre postérieure en extracapsulaire.

PURPOSE: Checking visual results and progression after cataract surgery in uveitis patients. METHODS: Fourteen eyes of 13 patients were retrospectively studied after cataract extraction from December 1993 to April 1997. We describe the surgical procedure followed by the visual outcome of cataract surgery, complications, and treatment. RESULTS: Specific uveitic syndromes were determined in eight patients. Fuchs' heterochromic iridocyclitis was the cause in three cases, ankylosing spondylitis in one case, sarcoidosis in two cases, toxoplasmosis in one case and Birdshot chorioretinopathy in one case. Phacoemulsification was performed in 10 eyes and a manual extracapsular procedure in four eyes. Posterior chamber implantation was performed in 13 cases. Final visual acuity improved in 64% cases, from 1 to 8 lines (average 3.5). Eight eyes had visual acuity worse than 5/10, attributed to posterior segment abnormalities, in particular macular edema, which is the main limiting factor of optimal visual recovery. Capsular opacification was the most frequent complication in the anterior segment. Endophthalmitis was described in one patient. CONCLUSION: Visual results of cataract surgery depend on different uveitic entities and on posterior segment abnormalities. Results are generally successful when uveitis is not severe and the posterior segment can be carefully observed after cataract surgery. Extracapsular cataract extraction and posterior chamber implantation seem to be well tolerated if inflammation is perfectly under control before surgery.

[Cost of managing cataracts. Evaluation of traditional hospitalization and ambulatory surgery]. / Coût de la prise en charge de la cataracte. Evaluation en hospitalisation traditionnelle et en chirurgie de jour.

OBJECTIVE: Demonstrate eventual differences and evaluate the medical costs of treatment of a cataract in traditional hospitalisation and out-patient surgical conditions. METHODS: We conducted a study of minimisation costs in 3 ophthalmologic hospital departments. This retrospective study randomly selected the medical files of 250 patients (100 operated in the out-patient surgical department and 150 operated in traditional surgical conditions). Costs were evaluated on direct hospital costs, according to the standard costs method and the method of true costs. RESULTS: The mean total cost of a cataract is of 10,984 F in traditional hospital conditions and of 7,683 F in out-patient surgical conditions. DISCUSSION: In terms of direct hospital costs, treatment of cataracts in out-patient surgery appears more economic compared with traditional surgery. The difference in cost concerned the fixed hospital charges (structures and staff). CONCLUSION: Out-patient surgery will progress in France in the next few years, but traditional hospitalisation will still be required in ophthalmologic practice.